Provider Demographics
NPI:1063104396
Name:MELLENTINE, RACHEL LYNN (LLPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:MELLENTINE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15312 W BURT RD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-9536
Mailing Address - Country:US
Mailing Address - Phone:989-903-9172
Mailing Address - Fax:
Practice Address - Street 1:3550 SHATTUCK RD STE C
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3153
Practice Address - Country:US
Practice Address - Phone:989-903-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health