Healthcare Provider Details

I. General information

NPI: 1306544846
Provider Name (Legal Business Name): STEPHANIE LYNN GEORGE-MELLO LMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 WATT AVE STE 150
SACRAMENTO CA
95821-6245
US

IV. Provider business mailing address

20059 BEAR RIDGE RD
GRASS VALLEY CA
95949-8327
US

V. Phone/Fax

Practice location:
  • Phone: 916-979-3520
  • Fax:
Mailing address:
  • Phone: 916-969-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: