Healthcare Provider Details

I. General information

NPI: 1932974409
Provider Name (Legal Business Name): MELISSA L BRIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 1/4 SHIRLEY PL
BEVERLY HILLS CA
90212-4124
US

IV. Provider business mailing address

405 1/4 SHIRLEY PL
BEVERLY HILLS CA
90212-4124
US

V. Phone/Fax

Practice location:
  • Phone: 310-904-3498
  • Fax:
Mailing address:
  • Phone: 310-904-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC12824
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberR-DMT-2757
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: