Provider Demographics
NPI:1376360164
Name:MCMILLAN, MELANIE (PSYCH ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:PSYCH ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22287 MULHOLLAND HWY # 664
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5157
Mailing Address - Country:US
Mailing Address - Phone:805-552-6999
Mailing Address - Fax:
Practice Address - Street 1:5727 CANOGA AVE APT 223
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6717
Practice Address - Country:US
Practice Address - Phone:805-552-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94028501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical