Provider Demographics
NPI:1720593411
Name:PARDO, MALISSA SUE (LMFT)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:SUE
Last Name:PARDO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MALISSA
Other - Middle Name:SUE
Other - Last Name:LAROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3343 CAPITAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7370
Mailing Address - Country:US
Mailing Address - Phone:279-321-1081
Mailing Address - Fax:
Practice Address - Street 1:3343 CAPITAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7370
Practice Address - Country:US
Practice Address - Phone:279-321-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT113715106H00000X
CAIMF101880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist