Provider Demographics
NPI:1659268811
Name:MELISSA JULIAN, PHD PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:MELISSA JULIAN, PHD PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-869-4112
Mailing Address - Street 1:11850 WILSHIRE BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6629
Mailing Address - Country:US
Mailing Address - Phone:310-869-4112
Mailing Address - Fax:
Practice Address - Street 1:11850 WILSHIRE BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6629
Practice Address - Country:US
Practice Address - Phone:310-869-4112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty