Provider Demographics
NPI:1922130996
Name:MELISSA PROSCH HUY
Entity Type:Organization
Organization Name:MELISSA PROSCH HUY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-936-0528
Mailing Address - Street 1:4700 E BRYSON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1901
Mailing Address - Country:US
Mailing Address - Phone:714-936-0528
Mailing Address - Fax:714-693-9333
Practice Address - Street 1:13 ORCHARD STE 103
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8321
Practice Address - Country:US
Practice Address - Phone:714-936-0528
Practice Address - Fax:714-693-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18078103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty