Provider Demographics
NPI:1326078031
Name:STILES, MELODY (MSW, LCSW, MAC, LCAC)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:
Last Name:STILES
Suffix:
Gender:F
Credentials:MSW, LCSW, MAC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29030 CALLE ALTA
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5642
Mailing Address - Country:US
Mailing Address - Phone:317-432-9633
Mailing Address - Fax:317-436-8139
Practice Address - Street 1:29030 CALLE ALTA
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5642
Practice Address - Country:US
Practice Address - Phone:317-432-9633
Practice Address - Fax:951-249-9738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049071041C0700X
IN34003930A1041C0700X
IN00178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)