Healthcare Provider Details

I. General information

NPI: 1356287213
Provider Name (Legal Business Name): MELISSA MCCONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA LAVERY

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 DOUBLE SPRINGS RD
VALLEY SPRINGS CA
95252-9275
US

IV. Provider business mailing address

8209 MOUNTAIN MEADOW DR
MOUNTAIN RANCH CA
95246-9445
US

V. Phone/Fax

Practice location:
  • Phone: 209-329-2957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: