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1417491028
MELISSA PROVOST
ESCONDIDO, CA
NPI
1417491028
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Additional Taxonomies
106S00000X Behavior Technician
Enumeration Date
2016-12-15
Last Update Date
2021-12-20
Business Address
MELISSA PROVOST
490 N GRAPE ST
ESCONDIDO, CA 92025-3079
Phone number: 760-975-9939
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Mailing Address
MELISSA PROVOST
490 N GRAPE ST
ESCONDIDO, CA 92025-3079
Phone number: 760-975-9939
Copy
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