=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023834611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE BELLEW LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2024
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 MILLER COUNTY 484
-----------------------------------------------------
City | FOUKE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71837-9454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-490-8810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5317 EAST ST
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71854-7612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-490-8810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 26284-M
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------