Provider Demographics
NPI:1609176643
Name:SCOTT, MELANIE (PSYD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:CRUMBIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27405 PUERTA REAL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6314
Mailing Address - Country:US
Mailing Address - Phone:949-391-7814
Mailing Address - Fax:949-861-9985
Practice Address - Street 1:27405 PUERTA REAL
Practice Address - Street 2:SUITE 150
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6314
Practice Address - Country:US
Practice Address - Phone:949-391-7814
Practice Address - Fax:949-861-9985
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2995103TA0400X
CT2996103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)