MEDICARE: ANDREA MELLER

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	106H00000X	Marriage & Family Therapist	163561	CA

General Provider Information

NPI Number	:	1336822139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MELLER

Provider Business Mailing Address
First Line	:	17 LIBERTY LN
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2186
Country	:	US
Telephone Number	:	310-709-1020
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 LIBERTY LN
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2186
Country	:	US
Telephone Number	:	415-766-0581
Fax Number	:

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

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	06/03/2026

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Directions to “ ANDREA MELLER ” Practice Location

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