Provider Demographics
NPI:1710374665
Name:DEBRA MELMON
Entity Type:Organization
Organization Name:DEBRA MELMON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:650-465-2903
Mailing Address - Street 1:1059 EL MONTE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4601
Mailing Address - Country:US
Mailing Address - Phone:650-465-2903
Mailing Address - Fax:
Practice Address - Street 1:1059 EL MONTE AVE STE B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4601
Practice Address - Country:US
Practice Address - Phone:650-465-2903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50592251S00000X, 283Q00000X, 302R00000X, 385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No251S00000XAgenciesCommunity/Behavioral Health
No283Q00000XHospitalsPsychiatric Hospital
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child