Healthcare Provider Details

I. General information

NPI: 1427278381
Provider Name (Legal Business Name): MELODY ANNE BROTBY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S FOREST RD STE 1-D
SONORA CA
95370-4895
US

IV. Provider business mailing address

101 S FOREST RD STE 1-D
SONORA CA
95370-4895
US

V. Phone/Fax

Practice location:
  • Phone: 209-206-0938
  • Fax:
Mailing address:
  • Phone: 209-206-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC19892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: