Provider Demographics
NPI:1700981305
Name:GALLARDO, MELISSA SUE (AA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC4 BOX 49024
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101
Mailing Address - Country:US
Mailing Address - Phone:530-233-4577
Mailing Address - Fax:
Practice Address - Street 1:441 NO MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101
Practice Address - Country:US
Practice Address - Phone:530-233-6319
Practice Address - Fax:530-233-5311
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health