=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295058469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN M. SPRAGUE M.S., B.C.B.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2010
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29995 TECHNOLOGY DR STE 102
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-297-2520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30650 RANCHO CALIFORNIA RD STE D406-139
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92591-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-297-2520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-09-6422
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------