Provider Demographics
NPI:1174171557
Name:LAND, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARVEY WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2103
Mailing Address - Country:US
Mailing Address - Phone:831-425-8132
Mailing Address - Fax:
Practice Address - Street 1:380 ENCINAL STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-469-1700
Practice Address - Fax:831-425-1905
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAASW105110104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health