Provider Demographics
NPI:1750944807
Name:MEGESI, NICHOLAS SCOTT (CCAPP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:MEGESI
Suffix:
Gender:M
Credentials:CCAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10936 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2724
Mailing Address - Country:US
Mailing Address - Phone:714-952-4032
Mailing Address - Fax:714-952-4075
Practice Address - Street 1:10936 DALE AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2724
Practice Address - Country:US
Practice Address - Phone:714-952-4032
Practice Address - Fax:714-952-4075
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)