Provider Demographics
NPI:1194157917
Name:BENTLEY, MELISSA ELIZABETH
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELIZABETH
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:3440 AIRWAY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2065
Mailing Address - Country:US
Mailing Address - Phone:707-544-3299
Mailing Address - Fax:707-544-6837
Practice Address - Street 1:3440 AIRWAY DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2065
Practice Address - Country:US
Practice Address - Phone:707-544-3299
Practice Address - Fax:707-544-6837
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist