Provider Demographics
NPI:1063545192
Name:BLACKWELL, MELANIE ELLEN (MA,LMHC,NCC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELLEN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MA,LMHC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N FERNCREEK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4127
Mailing Address - Country:US
Mailing Address - Phone:407-895-1155
Mailing Address - Fax:407-898-9321
Practice Address - Street 1:800 N FERNCREEK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4127
Practice Address - Country:US
Practice Address - Phone:407-895-1155
Practice Address - Fax:407-898-9321
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health