Provider Demographics
NPI:1619127073
Name:NIELSEN, MELINDA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:LEE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 REDCLIFF DR
Mailing Address - Street 2:220
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0157
Mailing Address - Country:US
Mailing Address - Phone:530-356-5592
Mailing Address - Fax:
Practice Address - Street 1:405 REDCLIFF DR
Practice Address - Street 2:220
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0157
Practice Address - Country:US
Practice Address - Phone:530-356-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical