Provider Demographics
NPI:1447381082
Name:SMITH, MELISSA LASHIELD (MS)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LASHIELD
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S BEVERLY DR
Mailing Address - Street 2:SUITE #128
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3851
Mailing Address - Country:US
Mailing Address - Phone:310-994-6584
Mailing Address - Fax:
Practice Address - Street 1:269 S BEVERLY DR
Practice Address - Street 2:SUITE #128
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3851
Practice Address - Country:US
Practice Address - Phone:310-994-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist