Provider Demographics
NPI:1245441856
Name:HENRICH, MELANIE MANIPOD (LMFT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MANIPOD
Last Name:HENRICH
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 1:831 ALAMO DRIVE
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688
Mailing Address - Country:US
Mailing Address - Phone:707-624-9767
Mailing Address - Fax:707-471-4140
Practice Address - Street 1:831 ALAMO DRIVE
Practice Address - Street 2:SUITE 6C
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688
Practice Address - Country:US
Practice Address - Phone:707-624-9767
Practice Address - Fax:707-471-4140
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 61994106H00000X
CALMFT94790106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health