Provider Demographics
NPI:1225360431
Name:PEDERSEN, MELISSA FRANCES (MFT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:FRANCES
Last Name:PEDERSEN
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 1:739 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3601
Mailing Address - Country:US
Mailing Address - Phone:310-801-8152
Mailing Address - Fax:310-519-3980
Practice Address - Street 1:739 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3601
Practice Address - Country:US
Practice Address - Phone:310-801-8152
Practice Address - Fax:310-519-3980
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist