Provider Demographics
NPI:1326542911
Name:COURTER, MELISSA MAXINE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MAXINE
Last Name:COURTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 HESTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5219
Mailing Address - Country:US
Mailing Address - Phone:323-243-1252
Mailing Address - Fax:
Practice Address - Street 1:1565 THE ALAMEDA STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2328
Practice Address - Country:US
Practice Address - Phone:408-320-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty