Healthcare Provider Details

I. General information

NPI: 1891653366
Provider Name (Legal Business Name): MELISSA LALANDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 COUNTRY CLUB DR APT 14
SIMI VALLEY CA
93065-6692
US

IV. Provider business mailing address

375 COUNTRY CLUB DR APT 14
SIMI VALLEY CA
93065-6692
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-0793
  • Fax:
Mailing address:
  • Phone: 562-346-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB00002271121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: