Provider Demographics
NPI:1891083911
Name:MACE, MELISSE ELAINE
Entity Type:Individual
Prefix:
First Name:MELISSE
Middle Name:ELAINE
Last Name:MACE
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 1:233 S QUINTANA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4029
Mailing Address - Country:US
Mailing Address - Phone:714-998-9813
Mailing Address - Fax:714-282-2801
Practice Address - Street 1:233 S QUINTANA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4029
Practice Address - Country:US
Practice Address - Phone:714-998-9813
Practice Address - Fax:714-282-2801
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health