Provider Demographics
NPI:1306446042
Name:GORCZYCA, MELODY KIANNA (LMFT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:KIANNA
Last Name:GORCZYCA
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 1:1507 E VALLEY PKWY
Mailing Address - Street 2:STE 3 #495
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027
Mailing Address - Country:US
Mailing Address - Phone:657-341-8224
Mailing Address - Fax:
Practice Address - Street 1:27368 VIA INDUSTRIA STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4852
Practice Address - Country:US
Practice Address - Phone:951-414-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT135183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist