Healthcare Provider Details

I. General information

NPI: 1952825390
Provider Name (Legal Business Name): MEGHAN COSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S DORA ST
UKIAH CA
95482-6340
US

IV. Provider business mailing address

1120 S DORA ST
UKIAH CA
95482-6340
US

V. Phone/Fax

Practice location:
  • Phone: 707-830-0983
  • Fax:
Mailing address:
  • Phone: 707-830-0983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: