Provider Demographics
NPI:1306695879
Name:MELLINGER, KENNA (MFT)
Entity type:Individual
Prefix:
First Name:KENNA
Middle Name:
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 VALLEY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2033
Mailing Address - Country:US
Mailing Address - Phone:215-859-0500
Mailing Address - Fax:
Practice Address - Street 1:641 N 13TH SIMON SILK MILL
Practice Address - Street 2:SUITE E101
Practice Address - City:LEHIGH VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:267-838-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist