Provider Demographics
NPI:1275195190
Name:MELCHOR, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MELCHOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 MANHATTAN BEACH BLVD
Mailing Address - Street 2:UNIT 110
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4960
Mailing Address - Country:US
Mailing Address - Phone:562-270-5041
Mailing Address - Fax:
Practice Address - Street 1:806 MANHATTAN BEACH BLVD
Practice Address - Street 2:UNIT 110
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4960
Practice Address - Country:US
Practice Address - Phone:562-270-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138432106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist