Provider Demographics
NPI:1710541875
Name:SOLEM, MELISSA ELIZABETH I (LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:SOLEM
Suffix:I
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2630
Mailing Address - Country:US
Mailing Address - Phone:602-820-7084
Mailing Address - Fax:
Practice Address - Street 1:11515 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5913
Practice Address - Country:US
Practice Address - Phone:310-881-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist