Healthcare Provider Details

I. General information

NPI: 1104462779
Provider Name (Legal Business Name): MELI MUSIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16133 VENTURA BLVD FL 7
ENCINO CA
91436-2403
US

IV. Provider business mailing address

PO BOX 56015
HARWOOD HEIGHTS IL
60656-0922
US

V. Phone/Fax

Practice location:
  • Phone: 747-777-0451
  • Fax: 747-777-0451
Mailing address:
  • Phone: 818-394-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELISSA SOMMERS
Title or Position: OWNER
Credential:
Phone: 747-777-0451