Provider Demographics
NPI:1043794449
Name:BAXTER, MELISSA MARIA (CADC II)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIA
Last Name:BAXTER
Suffix:
Gender:F
Credentials:CADC II
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 366
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95423-0366
Mailing Address - Country:US
Mailing Address - Phone:707-998-1800
Mailing Address - Fax:707-998-0122
Practice Address - Street 1:14715 EAST HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95423
Practice Address - Country:US
Practice Address - Phone:707-998-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAR1331731218101YA0400X
CAA063290923101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)