Provider Demographics
NPI:1720520133
Name:HERRON, MEGHAN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 SHIELDS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4245
Mailing Address - Country:US
Mailing Address - Phone:714-797-7207
Mailing Address - Fax:
Practice Address - Street 1:2121 S TOWNE CENTRE PL
Practice Address - Street 2:SUITE 370
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6122
Practice Address - Country:US
Practice Address - Phone:714-697-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13786103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst