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General NPI Number Information
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NPI Number | 1972367662
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Entity Type | Individual
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Provider Name | MELISSA ANN WATTE
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Gender | Female
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 388 S LOS ROBLES AVE APT 205
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City | PASADENA
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State | CA
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Zip | 91101-3842
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Country | US
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Telephone | 626-737-4335
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Fax |
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Provider Business Mailing Address
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Address Line | 254 N MAR VISTA AVE UNIT 3
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City | PASADENA
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State | CA
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Zip | 91106-1458
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Country | US
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Telephone | 626-841-3313
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC15168
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT142795
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License Number State | CA
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