MEDICARE: MARK MELTEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	16750	CA

General Provider Information

NPI Number	:	1215500640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MELTEN

Provider Business Mailing Address
First Line	:	PO BOX 4526
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95604-4526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10821 FAIR OAKS BLVD
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-7214
Country	:	US
Telephone Number	:	916-516-1560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	09/09/2024

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Directions to “ MARK MELTEN ” Practice Location

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