Provider Demographics
NPI:1396210662
Name:TAKAMORI, MEAGAN A (CDPT)
Entity Type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:A
Last Name:TAKAMORI
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:MS
Other - First Name:MEAGAN
Other - Middle Name:A
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:201 E LINCOLN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2348
Mailing Address - Country:US
Mailing Address - Phone:509-457-5653
Mailing Address - Fax:509-457-3107
Practice Address - Street 1:201 E LINCOLN AVE STE 100
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2348
Practice Address - Country:US
Practice Address - Phone:509-457-5653
Practice Address - Fax:509-457-3107
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60775656101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)