Provider Demographics
NPI:1154076552
Name:AVINA, MELISSA ESTEFANIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ESTEFANIE
Last Name:AVINA
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 N BACKER AVE UNIT 141
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-7505
Mailing Address - Country:US
Mailing Address - Phone:559-871-5249
Mailing Address - Fax:
Practice Address - Street 1:2350 W SHAW AVE STE 116
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3412
Practice Address - Country:US
Practice Address - Phone:559-573-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT153262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT153262OtherBBS
CAAMFT131030OtherBBS