Healthcare Provider Details

I. General information

NPI: 1457617078
Provider Name (Legal Business Name): MELISA M SANCHEZ LANDGRAF MS ED., LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 NEW VISION DR
FORT WAYNE IN
46845-1708
US

IV. Provider business mailing address

3804 NEW VISION DR
FORT WAYNE IN
46845-1708
US

V. Phone/Fax

Practice location:
  • Phone: 260-373-0880
  • Fax:
Mailing address:
  • Phone: 260-373-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number85000090A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: