Healthcare Provider Details

I. General information

NPI: 1073810305
Provider Name (Legal Business Name): MS. KRISTEN MICHELLE MELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 S JONES BLVD SUITE 230
LAS VEGAS NV
89146-5395
US

IV. Provider business mailing address

2920 S JONES BLVD SUITE 230
LAS VEGAS NV
89146-5395
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-5268
  • Fax: 702-485-1107
Mailing address:
  • Phone: 702-806-5268
  • Fax: 702-485-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0219
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: