Healthcare Provider Details

I. General information

NPI: 1184353930
Provider Name (Legal Business Name): MELYNDA PEEBLES ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BAUCHET ST
LOS ANGELES CA
90012-2907
US

IV. Provider business mailing address

450 BAUCHET ST
LOS ANGELES CA
90012-2907
US

V. Phone/Fax

Practice location:
  • Phone: 213-473-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW116072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: