Provider Demographics
NPI:1306203724
Name:HATHERLEY, MEGAN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HATHERLEY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11535 AVENUE 264
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9315
Mailing Address - Country:US
Mailing Address - Phone:559-747-3984
Mailing Address - Fax:
Practice Address - Street 1:11535 AVENUE 264
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9315
Practice Address - Country:US
Practice Address - Phone:559-747-3984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA1-16-23635103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health