MEDICARE: MEGAN ANN DEJEAN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1689974248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ANN DEJEAN

Provider Business Mailing Address
First Line	:	30011 IVY GLENN DR STE 105B
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-5015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30011 IVY GLENN DR STE 105B
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-5015
Country	:	US
Telephone Number	:	619-445-0405
Fax Number	:

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	07/19/2022

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