Provider Demographics
NPI:1669590097
Name:FACELLI, MELINDA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
Last Name:FACELLI
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 1:411 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2618
Mailing Address - Country:US
Mailing Address - Phone:916-783-0563
Mailing Address - Fax:
Practice Address - Street 1:411 OAK ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2618
Practice Address - Country:US
Practice Address - Phone:916-783-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist