Healthcare Provider Details

I. General information

NPI: 1184280976
Provider Name (Legal Business Name): MELODY YODER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY MANWELL LPC

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S 4TH ST
STURGIS MI
49091-1820
US

IV. Provider business mailing address

116 S 4TH ST
STURGIS MI
49091-1820
US

V. Phone/Fax

Practice location:
  • Phone: 269-210-3983
  • Fax:
Mailing address:
  • Phone: 269-210-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401226602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: