Provider Demographics
NPI:1942781687
Name:MELLINGER, JANIS ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:ANN
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2529
Mailing Address - Country:US
Mailing Address - Phone:619-957-3240
Mailing Address - Fax:
Practice Address - Street 1:4145 ACACIA AVE
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2529
Practice Address - Country:US
Practice Address - Phone:619-957-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23678101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional