Provider Demographics
NPI:1902249444
Name:MERRELL, MEGAN HAFEN (PHD, BCBA-D)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:HAFEN
Last Name:MERRELL
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:HAFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 PASEO CAMARILLO STE 235
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-0754
Mailing Address - Country:US
Mailing Address - Phone:805-383-5566
Mailing Address - Fax:888-659-0031
Practice Address - Street 1:1000 PASEO CAMARILLO STE 235
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-0754
Practice Address - Country:US
Practice Address - Phone:805-383-5566
Practice Address - Fax:888-659-0031
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-10396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-12-10396OtherBCBA