Provider Demographics
NPI:1669132098
Name:WILCOX, MEGAN WOOD (LMFT #130122)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:WOOD
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMFT #130122
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4571 POMONA AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-8713
Mailing Address - Country:US
Mailing Address - Phone:619-962-7781
Mailing Address - Fax:
Practice Address - Street 1:4571 POMONA AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-8713
Practice Address - Country:US
Practice Address - Phone:619-962-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist