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General NPI Number Information
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NPI Number | 1982984480
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Entity Type | Individual
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Provider Name | MELYSSA MACQUARRIE PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2011
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Last Update Date | 12/24/2022
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Provider Practice Location Address
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Address Line | 29900 GROUSE DR
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City | TEHACHAPI
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State | CA
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Zip | 93561-5126
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Country | US
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Telephone | 714-396-8037
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Fax |
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Provider Business Mailing Address
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Address Line | 150 PAULARINO AVE SUITE C-100
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City | COSTA MESA
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State | CA
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Zip | 92626-3301
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Country | US
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Telephone | 714-396-8037
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 18134
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License Number State | CA
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