Provider Demographics
NPI:1184779696
Name:ULVILA, MELANIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ANN
Last Name:ULVILA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 S STATE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5858
Mailing Address - Country:US
Mailing Address - Phone:707-463-4915
Mailing Address - Fax:707-463-4917
Practice Address - Street 1:776 S STATE ST STE 107
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5858
Practice Address - Country:US
Practice Address - Phone:707-463-4915
Practice Address - Fax:707-463-4917
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical