Melissa Linda Bautista, LPCC
Individual provider Active NPI Professional Counselor · Beaumont, CA
NPI 1053037515 · NPPES record last updated Mar 1, 2023
Key facts
- NPI
- 1053037515
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 8904 (CA)
- Practice address
- 305 W 4TH St
Beaumont, CA 92223-2611 - Phone
- (951) 878-5199
- NPI assigned
- Oct 17, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sud Specialty Group - Ca
Practice addresses (Care Compare)
5201 Great America Pkwy
Suite 320
Santa Clara, CA 95054-1140
Phone (323) 968-6182
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250131000466 | CA | Practitioner - Mental Health Counselor | 0446789713 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8904 | CA | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sud Specialty Group - Ca | Current |
Accepting new patients |
Locations
5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182
520 Broadway
Ste 200
Santa Monica, CA 90401
Phone (949) 280-5295
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 8904 | CA | Yes |
Addresses
Primary practice location
305 W 4TH St
Beaumont, CA 92223-2611
Mailing address
338 Olive Ave
Beaumont, CA 92223-2654
Other providers in Beaumont, CA
- Dean Baranski
- Daisy Barragan
- Kevin Julius Barrett
- Mariah Michelle Barsi
- Omar J Bashir
- Angela Beal
- Beaumont Chiropractic
- Beaumont Dental Group
- Beaumont Manor LLC
- Beaumont Radiology Services LLC
All providers in Beaumont, CA · Professional Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.