Healthcare Provider Details

I. General information

NPI: 1750462990
Provider Name (Legal Business Name): MELANIE CAMPBELL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE BOATRIGHT MA

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 3RD STREET NE
CULLMAN AL
35055
US

IV. Provider business mailing address

1559 3RD STREET NE
CULLMAN AL
35055
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-9569
  • Fax: 256-739-9569
Mailing address:
  • Phone: 256-739-9569
  • Fax: 256-739-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2384
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1700180734
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerPRACTICE NPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: