Provider Demographics
NPI:1326738675
Name:MOON, MELISSA (APCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:VANDERMOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 S RANDOLPH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16042 CLEARBROOK LN
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1962
Practice Address - Country:US
Practice Address - Phone:510-378-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC9026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health