Provider Demographics
NPI:1225639321
Name:GOODNOUGH, MEGAN KAY
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KAY
Last Name:GOODNOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44864 CORTE CASA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1603
Mailing Address - Country:US
Mailing Address - Phone:951-383-9991
Mailing Address - Fax:
Practice Address - Street 1:44864 CORTE CASA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-1603
Practice Address - Country:US
Practice Address - Phone:951-383-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician