Individual
ASHLEY MELISSA TATE DE LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
650 N WINCHESTER BLVD, SUITE 4, SAN JOSE, CA 95128-1511
(650) 271-4621
Mailing address
1800 HARRISON ST, 7TH FL, OAKLAND, CA 94612-3429
(510) 625-4101
(877) 738-4262
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY23064
CA
Other
Enumeration date
10/15/2009
Last updated
01/20/2022
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