Provider Demographics
NPI:1275872012
Name:BARNES, MELISSIA (MFTI 64402)
Entity Type:Individual
Prefix:MS
First Name:MELISSIA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:MFTI 64402
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 60TH ST UNIT 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6506
Mailing Address - Country:US
Mailing Address - Phone:619-990-0259
Mailing Address - Fax:
Practice Address - Street 1:1012 C ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5522
Practice Address - Country:US
Practice Address - Phone:619-239-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist