Basic Information
| Provider Information | |||||||||
| NPI: | 1285757708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELLEGERS | ||||||||
| FirstName: | LUCRECIA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MFT-INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2712 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154012750 | ||||||||
| FaxNumber: | 4154012774 | ||||||||
| Practice Location | |||||||||
| Address1: | 2712 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154012750 | ||||||||
| FaxNumber: | 4154012774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 12/03/2013 | ||||||||
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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 | IMF51486 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 72235 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 10381 | 01 | CBHS INTERNAL USE ONLY-COMMERCIAL NUMBER | OTHER | 10381 | 01 | SFGH INTERNAL USE ONLY | OTHER |