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Provider Information for 1164730560


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MELANIE LYNN FIKSE


Sex: Female

NPI: 1164730560
Last Updated: 2023-11-25
Certification Date: 2023-11-25

Details

NameValue
NPI1164730560
Enumeration Date2010-09-20
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 412 E MAIN ST STE F
GRASS VALLEY, CA 95945-6533
United States

Phone: 415-490-7510 | Fax:
 
Primary Practice Address 412 E MAIN ST STE F
GRASS VALLEY, CA 95945-6533
United States

Phone: 415-490-7510 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YM0800X - Counselor - Mental HealthNYP81186
Yes 101YM0800X - Counselor - Mental HealthCALPCC3363