Provider Demographics
NPI:1609653930
Name:BROWN, MEGAN LEIGH (EDS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:BROWN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 SYCAMORE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4579
Mailing Address - Country:US
Mailing Address - Phone:502-235-4823
Mailing Address - Fax:
Practice Address - Street 1:5256 SYCAMORE CREEK CT
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-4579
Practice Address - Country:US
Practice Address - Phone:502-235-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1889047103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool