Healthcare Provider Details

I. General information

NPI: 1649855198
Provider Name (Legal Business Name): MEL DAVID MCCORMICK AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E GISH RD
SAN JOSE CA
95112-4706
US

IV. Provider business mailing address

232 E GISH RD
SAN JOSE CA
95112-4706
US

V. Phone/Fax

Practice location:
  • Phone: 669-279-7270
  • Fax:
Mailing address:
  • Phone: 669-279-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: