Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003103458 |
---|---|
Provider Name | Mr. Johnny Josiah Meehan |
First Address | Chico, CA 95928-5508 |
Second Address | Chico, CA 95928-5508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 17/04/2014 |