Provider Demographics
NPI:1629409792
Name:BUDD-REYES, MEGAN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BUDD-REYES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N BRAND BLVD
Mailing Address - Street 2:#1000
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1906
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:3111 N TUSTIN ST
Practice Address - Street 2:#100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1750
Practice Address - Country:US
Practice Address - Phone:714-835-5587
Practice Address - Fax:818-241-6853
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14401103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-13-14401OtherBCBA