Healthcare Provider Details

I. General information

NPI: 1609948264
Provider Name (Legal Business Name): MELISSA PROSCH HUY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 EUREKA AVE SUITE G-4
YORBA LINDA CA
92886-3368
US

IV. Provider business mailing address

4430 E MIRALOMA AVE STE F
ANAHEIM CA
92807-1840
US

V. Phone/Fax

Practice location:
  • Phone: 714-936-0528
  • Fax: 714-693-9333
Mailing address:
  • Phone: 714-936-0528
  • Fax: 714-693-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 18078
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18078
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY18078
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY18078
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY18078
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY18978
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY18078
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY18078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: