Healthcare Provider Details

I. General information

NPI: 1679302368
Provider Name (Legal Business Name): MEL CIARAVINO LLC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W CASS ST UNIT 91
GREENVILLE MI
48838-5003
US

IV. Provider business mailing address

119 W CASS ST UNIT 91
GREENVILLE MI
48838-5003
US

V. Phone/Fax

Practice location:
  • Phone: 323-672-5951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023772
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: