Provider Demographics
NPI:1770969321
Name:LEBARON, MELODY
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:LEBARON
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 1:29736 SAN BRUNO AVE
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-1755
Mailing Address - Country:US
Mailing Address - Phone:909-215-1097
Mailing Address - Fax:
Practice Address - Street 1:16552 SUNHILL DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4518
Practice Address - Country:US
Practice Address - Phone:760-780-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist