Healthcare Provider Details

I. General information

NPI: 1720520133
Provider Name (Legal Business Name): MEGHAN HERRON MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S TOWNE CENTRE PL SUITE 370
ANAHEIM CA
92806-6122
US

IV. Provider business mailing address

6002 SHIELDS DR
HUNTINGTON BEACH CA
92647-4245
US

V. Phone/Fax

Practice location:
  • Phone: 714-697-6298
  • Fax:
Mailing address:
  • Phone: 714-797-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-13786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: