Healthcare Provider Details

I. General information

NPI: 1215383724
Provider Name (Legal Business Name): MEGAN MCGRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 N ROSEMEAD BLVD STE 103
PASADENA CA
91107-3001
US

IV. Provider business mailing address

1243 OAKRIDGE DR
GLENDALE CA
91205-3412
US

V. Phone/Fax

Practice location:
  • Phone: 626-372-1999
  • Fax: 626-737-6034
Mailing address:
  • Phone: 818-510-2338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: