Basic Information
| Provider Information | |||||||||
| NPI: | 1801188602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | GRIJALVA | ||||||||
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| Credential: | ACSW, CADC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4441 E KINGS CANYON RD | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937023604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596009180 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4785 N 1ST ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937260513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594484620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CI4500615 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 101056 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.