Healthcare Provider Details

I. General information

NPI: 1700214814
Provider Name (Legal Business Name): MELISSA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E
MURRAY UT
84121-1720
US

IV. Provider business mailing address

7859 VISTA VW
EAGLE MOUNTAIN UT
84005-5851
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-7138
  • Fax:
Mailing address:
  • Phone: 408-391-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number7979932-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: