Provider Demographics
NPI:1275868820
Name:ANDERSON, MELODIE ROWANE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:MELODIE
Middle Name:ROWANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 SUMMIT RIDGE TERRACE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:425-999-1027
Mailing Address - Fax:530-894-6722
Practice Address - Street 1:3167 SUMMIT RIDGE TERRACE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-894-6722
Practice Address - Fax:530-894-6722
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAML24320106H00000X
WALF60050291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist