Healthcare Provider Details

I. General information

NPI: 1306605894
Provider Name (Legal Business Name): MEGAN B. C. SMITH, PH.D., A PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OCEAN PARK BLVD STE 210
SANTA MONICA CA
90405-3230
US

IV. Provider business mailing address

3301 OCEAN PARK BLVD STE 210
SANTA MONICA CA
90405-3230
US

V. Phone/Fax

Practice location:
  • Phone: 424-432-0058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN B. C. SMITH
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 424-432-0058