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General NPI Number Information
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NPI Number | 1396023396
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Entity Type | Individual
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Provider Name | MELISSA R BROWNBACK MA, LPCC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1625 WHITE OAK ST
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City | COSTA MESA
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State | CA
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Zip | 92626-3724
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Country | US
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Telephone | 847-461-3406
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 WHITE OAK ST
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City | COSTA MESA
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State | CA
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Zip | 92626-3724
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Country | US
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Telephone | 847-461-3406
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.007010
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4726
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License Number State | CA
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