Doctor Name: | MELLISSA DERDER |
NPI Number: | 1417185059 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LVN |
License Number: | PT34371 |
Business Practice Address: | 592 Rio Lindo Ave Chico, CA - 959261817 |
Business Phone Number: | 5308912999 |
Business Fax Number: | |
Mailing Address: | 457 Scarlet Oak Dr, GRIDLEY |
State: | CA |
Postal Code: | 959483221 |
Phone Number: | 5308464888 |
Fax Number: | |
NPI Enumeration Date: | 06/22/2009 |
NPI Last Update Date: | 06/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 167G00000X |
License Number: | PT34371 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Licensed Psychiatric Technician |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |