Basic Information
| Provider Information | |||||||||
| NPI: | 1861573941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LELAND | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LELAND | ||||||||
| OtherFirstName: | MELANIE | ||||||||
| OtherMiddleName: | MISHKIN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19231 VICTORY BLVD | ||||||||
| Address2: | #110 | ||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913356308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187084500 | ||||||||
| FaxNumber: | 8186541956 | ||||||||
| Practice Location | |||||||||
| Address1: | 19231 VICTORY BLVD | ||||||||
| Address2: | #110 | ||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913356308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187084500 | ||||||||
| FaxNumber: | 8186541956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY 10354 | CA | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | PSY10354 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | PSY 10354 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC0700X | PSY 10354 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.