Provider Demographics
NPI:1831532191
Name:MARVIN, MELISSA KAY (LMFT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:MARVIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 LONGCOVE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1749
Mailing Address - Country:US
Mailing Address - Phone:209-610-9330
Mailing Address - Fax:
Practice Address - Street 1:829 ROSEMARIE LN STE G
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6221
Practice Address - Country:US
Practice Address - Phone:209-610-9330
Practice Address - Fax:209-451-3098
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48713106H00000X
CA48713106H00000X
CALMFT48713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist