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General NPI Number Information
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NPI Number | 1932284486
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Entity Type | Individual
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Provider Name | MELISSA L. RANDALL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/15/2019
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Provider Practice Location Address
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Address Line | 15300 VENTURA BLVD STE 410
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-5849
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Country | US
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Telephone | 818-399-9069
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Fax | 818-986-0496
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Provider Business Mailing Address
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Address Line | PO BOX 56355
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City | SHERMAN OAKS
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State | CA
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Zip | 91413-1355
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Country | US
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Telephone | 818-399-9069
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Fax | 818-986-0496
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY16375
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License Number State | CA
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