Provider Demographics
NPI:1376315986
Name:MELISSA L. EALBA, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:MELISSA L. EALBA, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-991-5010
Mailing Address - Street 1:1343 N GRAND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-4043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1343 N GRAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-4043
Practice Address - Country:US
Practice Address - Phone:626-991-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty