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General NPI Number Information
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NPI Number | 1861741647
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Entity Type | Individual
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Provider Name | MELANIE LOUISE MAILLOUX MS
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Gender | Female
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 6020 W MAPLE RD STE 501
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4409
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Country | US
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Telephone | 248-470-7967
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Fax | 248-764-5820
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Provider Business Mailing Address
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Address Line | 7003 DACOSTA ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2535
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Country | US
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Telephone | 313-485-0666
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401013962
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License Number State | MI
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