Provider Demographics
NPI:1467784967
Name:CHARGUALAF, MELISSA CASIL (MSCP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CASIL
Last Name:CHARGUALAF
Suffix:
Gender:F
Credentials:MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8073
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-8073
Mailing Address - Country:US
Mailing Address - Phone:671-929-6048
Mailing Address - Fax:
Practice Address - Street 1:430 ARMY DR
Practice Address - Street 2:BLDG 300 RM 104
Practice Address - City:BARRIGADA
Practice Address - State:GU
Practice Address - Zip Code:96913-1330
Practice Address - Country:US
Practice Address - Phone:671-929-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUIMF000093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist