Provider Demographics
NPI:1932766466
Name:CORNETT, MEGAN BREANNE
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BREANNE
Last Name:CORNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:BREANNE
Other - Last Name:HASEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12231 AVENUE 322
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1840 S CENTRAL ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4418
Practice Address - Country:US
Practice Address - Phone:559-741-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90949101YM0800X, 104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator