Basic Information
| Provider Information | |||||||||
| NPI: | 1912027517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPHERD | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | MICHELI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17171 ROSCOE BLVD | ||||||||
| Address2: | APT. 212-H | ||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913254060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187740241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23504 LYONS AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612862550 | ||||||||
| FaxNumber: | 6612862567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC37794 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.