MEDICARE: MELINDA SALLIS MFT-INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	MI4227	NV
2	101YM0800X	Mental Health Counselor	MI0828	NV
3	101YM0800X	Mental Health Counselor	MI4227	NV
4	106H00000X	Marriage & Family Therapist	MI0828	NV
5	106H00000X	Marriage & Family Therapist	MI4227	NV
6	172V00000X	Community Health Worker
7	101Y00000X	Counselor	MI0828	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679873137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA SALLIS MFT-INTERN

Provider Business Mailing Address
First Line	:	1512 DESTINY RIDGE CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-2948
Country	:	US
Telephone Number	:	702-478-0271
Fax Number	:

Provider Business Practice Location Address
First Line	:	4344 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:	702-675-6314
Fax Number	:	702-476-9697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	03/30/2023

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