Provider Demographics
NPI:1881139756
Name:HAN, MEYLIEN DARLENE (BSC)
Entity type:Individual
Prefix:
First Name:MEYLIEN
Middle Name:DARLENE
Last Name:HAN
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S 12TH ST APT D3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2458
Mailing Address - Country:US
Mailing Address - Phone:408-645-9539
Mailing Address - Fax:
Practice Address - Street 1:1400 PARKMOOR AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3797
Practice Address - Country:US
Practice Address - Phone:408-510-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor