Provider Demographics
NPI:1821463597
Name:MEGAN REESE BOAN, BCBA
Entity Type:Organization
Organization Name:MEGAN REESE BOAN, BCBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:REESE
Authorized Official - Last Name:BOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MS, BCBA
Authorized Official - Phone:706-575-8255
Mailing Address - Street 1:6036 OLDCASTLE PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2560
Mailing Address - Country:US
Mailing Address - Phone:706-575-8255
Mailing Address - Fax:
Practice Address - Street 1:6036 OLDCASTLE PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2560
Practice Address - Country:US
Practice Address - Phone:706-575-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-14-17802251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health