MEDICARE: KATELYN MELANCON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CIT-5560	LA
2	171M00000X	Case Manager/Care Coordinator		LA

General Provider Information

NPI Number	:	1750952578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN MELANCON

Provider Business Mailing Address
First Line	:	1120 GOVERNMENT ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-4802
Country	:	US
Telephone Number	:	225-888-5810
Fax Number	:	225-256-4210

Provider Business Practice Location Address
First Line	:	1120 GOVERNMENT ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-4802
Country	:	US
Telephone Number	:	225-888-5810
Fax Number	:	225-256-4210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	01/05/2026

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Directions to “ KATELYN MELANCON ” Practice Location

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