Provider Demographics
NPI:1801658687
Name:PFEFFERKORN, MEGAN (MA, AMFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PFEFFERKORN
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 TOLAND WAY APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3458
Mailing Address - Country:US
Mailing Address - Phone:626-539-3053
Mailing Address - Fax:
Practice Address - Street 1:11712 MOORPARK ST STE 204B
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2158
Practice Address - Country:US
Practice Address - Phone:626-539-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist