Provider Demographics
NPI:1669719100
Name:DOUGLASS, MELINDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BUSH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5239
Mailing Address - Country:US
Mailing Address - Phone:415-215-4796
Mailing Address - Fax:415-800-8480
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-215-4796
Practice Address - Fax:415-800-8480
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical