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General NPI Number Information
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NPI Number | 1235755968
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Entity Type | Individual
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Provider Name | KHRYSTYNA MELNYK
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Gender | Female
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 2075 W BIG BEAVER RD STE 520
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City | TROY
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State | MI
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Zip | 48084-3442
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Country | US
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Telephone | 248-646-6659
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Fax | 248-642-8645
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Provider Business Mailing Address
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Address Line | 4646 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-1916
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Country | US
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Telephone | 248-756-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301019538
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License Number State | MI
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