Provider Demographics
NPI:1376680611
Name:SANDEEN, MELISSA KATE (MFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATE
Last Name:SANDEEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6017
Mailing Address - Country:US
Mailing Address - Phone:707-442-8119
Mailing Address - Fax:707-826-1029
Practice Address - Street 1:1802 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2808
Practice Address - Country:US
Practice Address - Phone:707-443-7359
Practice Address - Fax:707-443-1092
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist