Provider Demographics
NPI:1154131985
Name:MELTON, DAVEON
Entity type:Individual
Prefix:
First Name:DAVEON
Middle Name:
Last Name:MELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 S WALNUT STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8431
Mailing Address - Country:US
Mailing Address - Phone:812-202-6001
Mailing Address - Fax:
Practice Address - Street 1:239 E WINSLOW RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8638
Practice Address - Country:US
Practice Address - Phone:812-202-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician