Healthcare Provider Details

I. General information

NPI: 1639488455
Provider Name (Legal Business Name): MELA COUNSELING SERVICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 WHITTIER BLVD
LOS ANGELES CA
90022-4222
US

IV. Provider business mailing address

5823 WHITTIER BL.
LOS ANGELES CA
90022
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-0100
  • Fax: 323-721-8631
Mailing address:
  • Phone: 323-728-0100
  • Fax: 323-721-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHY SALAZAR
Title or Position: DIRECTOR
Credential: RN
Phone: 323-728-0100