=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548327943
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN ARLENE PATRICK-THOMPSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 536 W VISTA WAY STE A
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-758-1650
-----------------------------------------------------
Fax | 619-233-0453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 536 W VISTA WAY STE A
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-758-1650
-----------------------------------------------------
Fax | 619-233-0453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY31035
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------