Provider Demographics
NPI:1962861443
Name:WHITE, MELINDA (MFT)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:SEIGEL-WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1635 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2108
Mailing Address - Country:US
Mailing Address - Phone:510-526-8208
Mailing Address - Fax:510-550-1991
Practice Address - Street 1:1635 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2108
Practice Address - Country:US
Practice Address - Phone:510-526-8208
Practice Address - Fax:510-550-1991
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT28729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist