Healthcare Provider Details

I. General information

NPI: 1952970998
Provider Name (Legal Business Name): MEGAN HENDERSON M.A. BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN GRINNEN

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 TECH BLVD STE 122
TAMPA FL
33619-7822
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 185-583-2672
  • Fax:
Mailing address:
  • Phone: 185-583-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52449
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-99868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: