Provider Demographics
NPI:1003077520
Name:KERSTEN, MELISSA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:KERSTEN
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 1:2086 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4902
Mailing Address - Country:US
Mailing Address - Phone:925-827-0212
Mailing Address - Fax:925-827-1122
Practice Address - Street 1:2086 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4902
Practice Address - Country:US
Practice Address - Phone:925-827-0212
Practice Address - Fax:925-827-1122
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 101Y00000X
CAMFC52367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor