Provider Demographics
NPI:1154709004
Name:MELTON, MICHAEL (BA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MELTON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 INGALLS ST
Mailing Address - Street 2:APT 307
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-8314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 INGALLS ST
Practice Address - Street 2:APT 307
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-8314
Practice Address - Country:US
Practice Address - Phone:720-401-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst