Provider Demographics
NPI:1386760478
Name:MELA COUNSELING SERVICES CENTER, INC.
Entity type:Organization
Organization Name:MELA COUNSELING SERVICES CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:323-721-6855
Mailing Address - Street 1:5723 WHITTIER BLVD
Mailing Address - Street 2:5721 WHITTIER BLVD.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4222
Mailing Address - Country:US
Mailing Address - Phone:323-721-6855
Mailing Address - Fax:323-721-8631
Practice Address - Street 1:5723 WHITTIER BLVD
Practice Address - Street 2:5721 WHITTIER BLVD.
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4222
Practice Address - Country:US
Practice Address - Phone:323-721-6855
Practice Address - Fax:323-721-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6710251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6710Medicaid