Healthcare Provider Details

I. General information

NPI: 1255462040
Provider Name (Legal Business Name): MELISSA DEPOORTER PHD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: