Healthcare Provider Details

I. General information

NPI: 1619367810
Provider Name (Legal Business Name): MELISSE TOKIC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 TUCKAHOE DR
NASHVILLE TN
37207-1640
US

IV. Provider business mailing address

1127 TUCKAHOE DR
NASHVILLE TN
37207-1640
US

V. Phone/Fax

Practice location:
  • Phone: 310-266-5044
  • Fax:
Mailing address:
  • Phone: 310-266-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1040
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: