=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558989467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA CASEBIER MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2020
-----------------------------------------------------
Last Update Date | 07/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 E REDLANDS BLVD STE 246
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-4725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-312-0232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25831 LOMAS VERDES ST
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-8405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-301-4330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT114134
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------