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Organization
KAISER PERMANENTE
Active
Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROGER JACKSON MELTON L.M.F.T. (COUNSELOR III)
(951) 601-6171
Entity
Organization
Contact information
Practice address
12815 HEACOCK ST, MORENO VALLEY, CA 92553-3116
(051) 601-6174
(951) 601-6224
Mailing address
12815 HEACOCK ST, MORENO VALLEY, CA 92553-3116
(051) 601-6174
(951) 601-6224
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
MFC17474
CA
Other
Enumeration date
06/28/2007
Last updated
08/22/2020
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