Provider Demographics
NPI:1306473988
Name:MELSON, MELANIE LYNNE (CDCA II)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNNE
Last Name:MELSON
Suffix:
Gender:F
Credentials:CDCA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 KILBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1324
Mailing Address - Country:US
Mailing Address - Phone:419-217-1353
Mailing Address - Fax:567-214-4209
Practice Address - Street 1:22 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818-9399
Practice Address - Country:US
Practice Address - Phone:419-983-4100
Practice Address - Fax:419-983-4103
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.173241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)