Healthcare Provider Details

I. General information

NPI: 1285394254
Provider Name (Legal Business Name): MELISSA ALLIE OLIVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ALLIE OLIVO

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 HOEN AVE
SANTA ROSA CA
95405-7824
US

IV. Provider business mailing address

4704 HOEN AVE
SANTA ROSA CA
95405-7824
US

V. Phone/Fax

Practice location:
  • Phone: 707-568-2800
  • Fax:
Mailing address:
  • Phone: 707-568-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141083
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: