Provider Demographics
NPI:1841417540
Name:HERST, MELVIN (MA)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:HERST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:MEL
Other - Middle Name:
Other - Last Name:HERST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:4151 E FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3023
Mailing Address - Country:US
Mailing Address - Phone:562-595-8111
Mailing Address - Fax:562-595-8148
Practice Address - Street 1:4151 E FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3023
Practice Address - Country:US
Practice Address - Phone:562-595-8111
Practice Address - Fax:562-595-8148
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0056OtherSCFFAA EMPLOYEE I.D.
CA00007300Medicaid
CASUBC442OtherLA DMH PROVIDER