Provider Demographics
NPI:1386169985
Name:MELTON, LAURA A
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:MELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 ETIWANDA AVE UNIT 184
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2539
Mailing Address - Country:US
Mailing Address - Phone:818-266-9600
Mailing Address - Fax:
Practice Address - Street 1:5700 ETIWANDA AVE UNIT 184
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2539
Practice Address - Country:US
Practice Address - Phone:818-266-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9625101YA0400X
CA6925101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty