Provider Demographics
NPI:1306152822
Name:DAVIS, MEGAN BETH (PHD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16274 APRICOT LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-8428
Mailing Address - Country:US
Mailing Address - Phone:831-320-9213
Mailing Address - Fax:
Practice Address - Street 1:2285 CHALLENGER WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407
Practice Address - Country:US
Practice Address - Phone:707-205-9149
Practice Address - Fax:707-569-2444
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103T00000X
CAPSY30750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist