Provider Demographics
NPI:1053564310
Name:KATES, MEGAN THOMPSON (PHD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:THOMPSON
Last Name:KATES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4203 GENESEE AVE
Mailing Address - Street 2:STE 103 BOX 224
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4950
Mailing Address - Country:US
Mailing Address - Phone:858-342-6270
Mailing Address - Fax:
Practice Address - Street 1:9040 FRIARS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5859
Practice Address - Country:US
Practice Address - Phone:619-284-6377
Practice Address - Fax:619-528-2841
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24940103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist