Healthcare Provider Details

I. General information

NPI: 1245624949
Provider Name (Legal Business Name): MELYSSA ZIVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5762 BOLSA AVE SUITE 101
HUNTINGTON BEACH CA
92649-1172
US

IV. Provider business mailing address

5762 BOLSA AVE SUITE 101
HUNTINGTON BEACH CA
92649-1172
US

V. Phone/Fax

Practice location:
  • Phone: 714-292-2322
  • Fax: 714-866-4153
Mailing address:
  • Phone: 714-292-2322
  • Fax: 714-866-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW70594
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2123
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: