Healthcare Provider Details

I. General information

NPI: 1124151618
Provider Name (Legal Business Name): SEAN T MEEHAN L.M.F.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 N HUDSON AVE
PASADENA CA
91101-1808
US

IV. Provider business mailing address

66 HURLBUT ST
PASADENA CA
91105-4025
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8471
  • Fax:
Mailing address:
  • Phone: 626-441-4221
  • Fax: 626-441-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number47610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: