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General NPI Number Information
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NPI Number | 1750952578
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Entity Type | Individual
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Provider Name | KATELYN MELANCON
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Gender | Female
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 624 CONNELL PARK LN STE A1
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City | BATON ROUGE
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State | LA
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Zip | 70806-6534
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Country | US
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Telephone | 225-468-6287
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Fax | 225-443-4733
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Provider Business Mailing Address
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Address Line | 8490 FAIRLANE DR
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-2033
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Country | US
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Telephone | 225-367-0695
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5560
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 5560
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License Number State | LA
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