Basic Information
| Provider Information | |||||||||
| NPI: | 1093169286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALOR | ||||||||
| FirstName: | MELANIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCC 4761 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 612 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912090612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183819695 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1540 E COLORADO ST | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912051514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182447257 | ||||||||
| FaxNumber: | 8182435431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2016 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1175 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | LPCC4761 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.