Provider Demographics
NPI:1316818842
Name:KULLMAN, MELISSA JEAN (LCSW LCS14396)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JEAN
Last Name:KULLMAN
Suffix:
Gender:F
Credentials:LCSW LCS14396
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7748 PASO ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2143
Mailing Address - Country:US
Mailing Address - Phone:818-468-7754
Mailing Address - Fax:
Practice Address - Street 1:7748 PASO ROBLES AVE
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-2143
Practice Address - Country:US
Practice Address - Phone:818-468-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS143961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical