Provider Demographics
NPI:1780220020
Name:OKEEFE, MELISSA RYAN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RYAN
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1244
Mailing Address - Country:US
Mailing Address - Phone:818-749-5164
Mailing Address - Fax:
Practice Address - Street 1:4521 SHERMAN OAKS AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3807
Practice Address - Country:US
Practice Address - Phone:818-900-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist