Provider Demographics
NPI:1861573941
Name:LELAND, MELANIE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANN
Last Name:LELAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:MISHKIN
Other - Last Name:LELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:#110
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6308
Mailing Address - Country:US
Mailing Address - Phone:818-708-4500
Mailing Address - Fax:818-654-1956
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:#110
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-708-4500
Practice Address - Fax:818-654-1956
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10354103T00000X, 103TC2200X, 103TC0700X
CAPSY10354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent