Provider Demographics
NPI:1699961920
Name:DELIS, MELISSA ANN (MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DELIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:PREWETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5301 OFFICE PARK DR STE 225400
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0677
Mailing Address - Country:US
Mailing Address - Phone:661-978-4779
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:5301 OFFICE PARK DR STE 225
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0666
Practice Address - Country:US
Practice Address - Phone:661-978-4779
Practice Address - Fax:661-397-8286
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF43883106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist