Healthcare Provider Details

I. General information

NPI: 1386264372
Provider Name (Legal Business Name): MEGAN EMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date: 08/04/2022
Reactivation Date: 09/07/2022

III. Provider practice location address

9500 MALECH DR
SAN JOSE CA
95138-2004
US

IV. Provider business mailing address

1659 SCOTT BLVD
SANTA CLARA CA
95050-4172
US

V. Phone/Fax

Practice location:
  • Phone: 408-281-6555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT157708
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: