Provider Demographics
NPI:1861019051
Name:MEYERS, MELINDA (MFC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 CLASSIC ROSE CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5134
Mailing Address - Country:US
Mailing Address - Phone:818-632-6830
Mailing Address - Fax:
Practice Address - Street 1:1764 CLASSIC ROSE CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-5134
Practice Address - Country:US
Practice Address - Phone:818-632-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty