Provider Demographics
NPI:1164827291
Name:YALLER, MELISSA LANI (LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LANI
Last Name:YALLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LANI
Other - Last Name:MINEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:530 E. LOS ANGELES AVE # 115-221
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021
Mailing Address - Country:US
Mailing Address - Phone:805-390-6062
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR.
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-981-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113712106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
56CCOtherASPIRA