Healthcare Provider Details

I. General information

NPI: 1205494986
Provider Name (Legal Business Name): MEGAN MEREDITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2744 E 11TH ST STE H1
OAKLAND CA
94601-1443
US

IV. Provider business mailing address

2744 E 11TH ST STE H1
OAKLAND CA
94601-1443
US

V. Phone/Fax

Practice location:
  • Phone: 510-621-9131
  • Fax:
Mailing address:
  • Phone: 510-437-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: