Provider Demographics
NPI:1225266141
Name:BURKHOLDER, MELANIE GAYLE (LPCC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:GAYLE
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 BLACK RAIL RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-2603
Mailing Address - Country:US
Mailing Address - Phone:760-683-9084
Mailing Address - Fax:
Practice Address - Street 1:6600 BLACK RAIL RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-2603
Practice Address - Country:US
Practice Address - Phone:760-683-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1977101YP2500X
WY1085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional