Healthcare Provider Details

I. General information

NPI: 1164730560
Provider Name (Legal Business Name): MELANIE LYNN FIKSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S AUBURN ST # B4
GRASS VALLEY CA
95945-6576
US

IV. Provider business mailing address

11057 COPPER DR
GRASS VALLEY CA
95945-7453
US

V. Phone/Fax

Practice location:
  • Phone: 415-490-7510
  • Fax:
Mailing address:
  • Phone: 415-490-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC3363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP6425-R
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP81186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: