Provider Demographics
NPI:1396353744
Name:SANDERSON, MELISSA LEANN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEANN
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 WEATHERFORD CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-1333
Mailing Address - Country:US
Mailing Address - Phone:805-404-0328
Mailing Address - Fax:
Practice Address - Street 1:3366 WEATHERFORD CT
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-1333
Practice Address - Country:US
Practice Address - Phone:805-404-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120280106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist