Healthcare Provider Details

I. General information

NPI: 1053973008
Provider Name (Legal Business Name): MEGGAN TAYLOR BUNCE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4206
US

IV. Provider business mailing address

2303 VIA CHALUPA
SAN CLEMENTE CA
92673-3603
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-9373
  • Fax:
Mailing address:
  • Phone: 949-547-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: