Provider Demographics
NPI:1336424548
Name:PINN, MELISSA (MFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PINN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:LERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3760 CONVOY ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3742
Mailing Address - Country:US
Mailing Address - Phone:858-633-6190
Mailing Address - Fax:
Practice Address - Street 1:3760 CONVOY ST
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3742
Practice Address - Country:US
Practice Address - Phone:858-633-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#46333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist