Healthcare Provider Details

I. General information

NPI: 1972868024
Provider Name (Legal Business Name): MS. MEGAN JUSTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN BROWN

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 W RAMSEY ST
BANNING CA
92220-4477
US

IV. Provider business mailing address

25699 SWEETLEAF ST
MORENO VALLEY CA
92553-4763
US

V. Phone/Fax

Practice location:
  • Phone: 951-849-7142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75179
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: