Provider Demographics
NPI:1215084041
Name:MELLON, MELISSA ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:MELLON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17772 IRVINE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3234
Mailing Address - Country:US
Mailing Address - Phone:714-388-6119
Mailing Address - Fax:
Practice Address - Street 1:17772 IRVINE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3234
Practice Address - Country:US
Practice Address - Phone:714-388-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40670106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist