Provider Demographics
NPI: | 1821405630 |
---|---|
Name: | CHU, MELODY |
Entity Type: | Individual |
Prefix: | |
First Name: | MELODY |
Middle Name: | |
Last Name: | CHU |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2275 ARLINGTON DR |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN LEANDRO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94578-1132 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 510-317-1444 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2275 ARLINGTON DR |
Practice Address - Street 2: | |
Practice Address - City: | SAN LEANDRO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94578-1132 |
Practice Address - Country: | US |
Practice Address - Phone: | 510-317-1444 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-07-14 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 63190 | 101Y00000X, 101YM0800X, 390200000X, 104100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |