MEDICARE: MEGAN BABCOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	124801	CA

General Provider Information

NPI Number	:	1285374579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN BABCOCK

Provider Business Mailing Address
First Line	:	1617 S PACIFIC COAST HWY STE B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 S PACIFIC COAST HWY STE B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5612
Country	:	US
Telephone Number	:	213-349-2505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	04/01/2022

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