Healthcare Provider Details

I. General information

NPI: 1083253959
Provider Name (Legal Business Name): MELANNY GARAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2019
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 ZELZAH AVE
NORTHRIDGE CA
91325-2003
US

IV. Provider business mailing address

14720 CULLEN ST
WHITTIER CA
90603-1920
US

V. Phone/Fax

Practice location:
  • Phone: 818-739-5604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: