Healthcare Provider Details

I. General information

NPI: 1942840905
Provider Name (Legal Business Name): MELISSA SONYA TINES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S FAIR OAKS AVE STE 310
PASADENA CA
91105-2012
US

IV. Provider business mailing address

107 S FAIR OAKS AVE STE 310
PASADENA CA
91105-2012
US

V. Phone/Fax

Practice location:
  • Phone: 626-219-0199
  • Fax:
Mailing address:
  • Phone: 213-910-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW122818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: