Provider Demographics
NPI:1609128115
Name:PAYER, MEGAN (PHD BCBA RYT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PAYER
Suffix:
Gender:F
Credentials:PHD BCBA RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 BURNING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4015
Mailing Address - Country:US
Mailing Address - Phone:805-901-2877
Mailing Address - Fax:
Practice Address - Street 1:1360 BURNING HILLS LN
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4015
Practice Address - Country:US
Practice Address - Phone:805-901-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13540103K00000X, 390200000X
CA94024720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program