Provider Demographics
NPI:1306688353
Name:BRYANT, MEGAN (BCBA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:BLACKSHIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1722 1/2 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1338
Mailing Address - Country:US
Mailing Address - Phone:323-744-1314
Mailing Address - Fax:
Practice Address - Street 1:1722 1/2 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1338
Practice Address - Country:US
Practice Address - Phone:323-744-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB404645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst