Healthcare Provider Details

I. General information

NPI: 1003726589
Provider Name (Legal Business Name): MELANIE FACUNDO LEP, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10862 SPENCEVILLE RD
PENN VALLEY CA
95946-9625
US

IV. Provider business mailing address

233 WISTERIA CT
ROSEVILLE CA
95678-1193
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-1118
  • Fax:
Mailing address:
  • Phone: 916-798-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: