Healthcare Provider Details

I. General information

NPI: 1649790064
Provider Name (Legal Business Name): MELISSA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date: 01/28/2025
Reactivation Date: 02/20/2025

III. Provider practice location address

1900 ATLANTIC AVE
LONG BEACH CA
90806-5502
US

IV. Provider business mailing address

733 1/2 DAWSON AVE
LONG BEACH CA
90804-4529
US

V. Phone/Fax

Practice location:
  • Phone: 562-277-9405
  • Fax: 562-216-6197
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT144253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: