Provider Demographics
NPI:1518115849
Name:HUGHES, MELODY ELLEN (MA, LMFT 86670)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ELLEN
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MA, LMFT 86670
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:ELLEN
Other - Last Name:KEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT 86670
Mailing Address - Street 1:401 BICENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2149
Mailing Address - Country:US
Mailing Address - Phone:707-571-3778
Mailing Address - Fax:
Practice Address - Street 1:3554 ROUND BARN BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0929
Practice Address - Country:US
Practice Address - Phone:707-571-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 65644106H00000X
390200000X
CAMFC86670106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program