Provider Demographics
NPI:1720403652
Name:KUBICEK, MEGAN RENE (MFTI)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENE
Last Name:KUBICEK
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RENE
Other - Last Name:HARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2505
Mailing Address - Country:US
Mailing Address - Phone:209-524-4858
Mailing Address - Fax:
Practice Address - Street 1:610 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2505
Practice Address - Country:US
Practice Address - Phone:209-524-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-01
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)