Provider Demographics
NPI:1770558744
Name:MILLER, MELISSA ELIZABETH (MA)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:4010 MOORPARK AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1803
Mailing Address - Country:US
Mailing Address - Phone:408-576-8333
Mailing Address - Fax:408-246-6746
Practice Address - Street 1:4010 MOORPARK AVE STE 118
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1803
Practice Address - Country:US
Practice Address - Phone:408-576-8333
Practice Address - Fax:408-246-6746
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist