Basic Information
| Provider Information | |||||||||
| NPI: | 1093832594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKS | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933041405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613244756 | ||||||||
| FaxNumber: | 6613241652 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933041405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613244756 | ||||||||
| FaxNumber: | 6613241652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 08/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | M0910222038 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.