Healthcare Provider Details

I. General information

NPI: 1235092602
Provider Name (Legal Business Name): MELISSA ELIZABETH ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 MCHENRY AVE
MODESTO CA
95350-4528
US

IV. Provider business mailing address

1539 MCHENRY AVE
MODESTO CA
95350-4528
US

V. Phone/Fax

Practice location:
  • Phone: 209-702-0139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21224
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: