Provider Demographics
NPI:1831637578
Name:ALLES, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ALLES
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 1:1400 N. NORMA ST.
Mailing Address - Street 2:SUITE 133
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-4569
Mailing Address - Country:US
Mailing Address - Phone:760-499-7406
Mailing Address - Fax:
Practice Address - Street 1:1400 N. NORMA ST.
Practice Address - Street 2:SUITE 133
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-4569
Practice Address - Country:US
Practice Address - Phone:760-499-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8577101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health