Provider Demographics
NPI:1154799492
Name:COULTER, MEGAN (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COULTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5808
Mailing Address - Country:US
Mailing Address - Phone:310-266-4091
Mailing Address - Fax:
Practice Address - Street 1:2444 WILSHIRE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-266-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS849341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical