Provider Demographics
NPI:1255926929
Name:SCHUTT, MELANIE ANN MARIE (PPS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN MARIE
Last Name:SCHUTT
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN MARIE
Other - Last Name:AKIKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1580 SHADOWRIDGE DR APT 167
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-9036
Mailing Address - Country:US
Mailing Address - Phone:619-768-3882
Mailing Address - Fax:
Practice Address - Street 1:1580 SHADOWRIDGE DR APT 167
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-9036
Practice Address - Country:US
Practice Address - Phone:619-768-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160164345103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool