Healthcare Provider Details

I. General information

NPI: 1184338410
Provider Name (Legal Business Name): MELINDA KAE MILLER LUCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDY KAE MILLER LUCIA

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 53RD ST
OAKLAND CA
94609-1814
US

IV. Provider business mailing address

1255 VAILWOOD DR
DANVILLE CA
94526-5051
US

V. Phone/Fax

Practice location:
  • Phone: 510-517-1333
  • Fax:
Mailing address:
  • Phone: 925-360-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT151882
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC18334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: