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General NPI Number Information
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NPI Number | 1992128318
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Entity Type | Individual
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Provider Name | JOHN L MELTON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 11778 HOLLYVIEW DR
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City | GREAT FALLS
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State | VA
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Zip | 22066-1330
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Country | US
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Telephone | 850-960-2036
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Fax |
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Provider Business Mailing Address
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Address Line | 11778 HOLLYVIEW DR
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City | GREAT FALLS
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State | VA
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Zip | 22066-1330
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Country | US
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Telephone | 850-960-2036
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1855
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301019216
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License Number State | MI
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