Provider Demographics
NPI:1891018701
Name:HURTADO-HAGHIGHI, MELISSA JASMINE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JASMINE
Last Name:HURTADO-HAGHIGHI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:JASMINE
Other - Last Name:HURTADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1191 TRIUMPHAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2925
Mailing Address - Country:US
Mailing Address - Phone:714-202-6689
Mailing Address - Fax:
Practice Address - Street 1:1191 TRIUMPHAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-2925
Practice Address - Country:US
Practice Address - Phone:714-202-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91201OtherBBS