Healthcare Provider Details

I. General information

NPI: 1467832956
Provider Name (Legal Business Name): MELODY HULITT-PILLOW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELODY DAWN HUNGERFORD LMSW

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 DAVID ST
COLOMA MI
49038-9726
US

IV. Provider business mailing address

230 DAVID ST
COLOMA MI
49038-9726
US

V. Phone/Fax

Practice location:
  • Phone: 269-462-1785
  • Fax:
Mailing address:
  • Phone: 269-462-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093897
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007478A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: