Healthcare Provider Details

I. General information

NPI: 1376823369
Provider Name (Legal Business Name): MELISSA ERIN TREVATHAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ERIN TREVATHAN-MINNIS PHD

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 YORK RD STE B12
BALTIMORE MD
21212-4245
US

IV. Provider business mailing address

2200 E LOMBARD ST
BALTIMORE MD
21231-2021
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-2476
  • Fax:
Mailing address:
  • Phone: 281-923-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: