Provider Demographics
NPI:1447658695
Name:WILLAN, MAEGAN (MFT)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:WILLAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9641
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-0641
Mailing Address - Country:US
Mailing Address - Phone:505-920-1289
Mailing Address - Fax:
Practice Address - Street 1:1600 SHATTUCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1634
Practice Address - Country:US
Practice Address - Phone:505-920-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist