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General NPI Number Information
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NPI Number | 1255462040
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Entity Type | Individual
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Provider Name | MELISSA DEPOORTER PHD, LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 10333 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422-5808
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Country | US
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Telephone | 805-468-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 10333 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422-5808
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 98751
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 33217
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License Number State | CA
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