Provider Demographics
NPI:1467026419
Name:KING, MELODY (LMFT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:KING
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 1:673 S AUBURN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7576
Mailing Address - Country:US
Mailing Address - Phone:530-913-5054
Mailing Address - Fax:844-335-6596
Practice Address - Street 1:673 S AUBURN ST STE B
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7576
Practice Address - Country:US
Practice Address - Phone:530-913-5054
Practice Address - Fax:844-335-6596
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT42859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist