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General NPI Number Information
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NPI Number | 1306473988
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Entity Type | Individual
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Provider Name | MELANIE LYNNE MELSON CDCA II
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 22 CLINTON ST
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City | BLOOMVILLE
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State | OH
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Zip | 44818-9399
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Country | US
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Telephone | 419-983-4100
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Fax | 419-983-4103
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Provider Business Mailing Address
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Address Line | 228 KILBOURNE ST
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City | BELLEVUE
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State | OH
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Zip | 44811-1324
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Country | US
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Telephone | 419-217-1353
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Fax | 567-214-4209
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.173241
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License Number State | OH
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