Provider Demographics
NPI:1417535386
Name:WINFREY, MEGAN (RBT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WINFREY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:WINFREY HERRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:242 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2264
Mailing Address - Country:US
Mailing Address - Phone:928-919-9521
Mailing Address - Fax:928-247-9101
Practice Address - Street 1:242 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2264
Practice Address - Country:US
Practice Address - Phone:928-919-9521
Practice Address - Fax:928-247-9101
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB651704106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician