Healthcare Provider Details

I. General information

NPI: 1144232885
Provider Name (Legal Business Name): JEFFREY MELVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 UNION DR STE 100
LINCOLN NE
68516-6629
US

IV. Provider business mailing address

3701 UNION DR STE 100
LINCOLN NE
68516-6629
US

V. Phone/Fax

Practice location:
  • Phone: 402-205-5677
  • Fax:
Mailing address:
  • Phone: 402-205-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number334
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number334
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: