Provider Demographics
NPI:1679122949
Name:SCOTT, MELISSA RENATA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENATA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RENATA
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:13967 CAMPO RD STE 202B
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-3232
Mailing Address - Country:US
Mailing Address - Phone:636-744-6996
Mailing Address - Fax:
Practice Address - Street 1:13967 CAMPO RD STE 202B
Practice Address - Street 2:
Practice Address - City:JAMUL
Practice Address - State:CA
Practice Address - Zip Code:91935-3232
Practice Address - Country:US
Practice Address - Phone:858-300-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist