Provider Demographics
NPI:1306194113
Name:CHAN, MELISSA TIN (MSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:TIN
Last Name:CHAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3631
Mailing Address - Country:US
Mailing Address - Phone:310-337-7417
Mailing Address - Fax:
Practice Address - Street 1:11401 BLOOMFIELD AVE
Practice Address - Street 2:305-307
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2015
Practice Address - Country:US
Practice Address - Phone:310-337-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health