Provider Demographics
NPI:1821961780
Name:MEIBEYER MILLER, MELISSA CAMPBELL MAHAN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAMPBELL MAHAN
Last Name:MEIBEYER MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410896
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94141-0896
Mailing Address - Country:US
Mailing Address - Phone:707-266-8269
Mailing Address - Fax:
Practice Address - Street 1:672 W 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3821
Practice Address - Country:US
Practice Address - Phone:209-401-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151515106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist