Healthcare Provider Details

I. General information

NPI: 1013318740
Provider Name (Legal Business Name): MELISSA FALLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 E COURT ST
SIDNEY OH
45365-3021
US

IV. Provider business mailing address

129 E COURT ST
SIDNEY OH
45365-3021
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-5195
  • Fax:
Mailing address:
  • Phone: 937-599-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00522
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: