Provider Demographics
NPI:1780025338
Name:KAE, MELISSA BESS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:BESS
Last Name:KAE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:BESS
Other - Last Name:KASTNER-TREISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11835 W OLYMPIC BLVD STE 1265E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-5814
Mailing Address - Country:US
Mailing Address - Phone:310-273-4843
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 1265E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5814
Practice Address - Country:US
Practice Address - Phone:310-273-4843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30108103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program