Provider Demographics
NPI:1306902457
Name:MELLENDORF, SONDRA KAY (MA,LPC)
Entity type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:KAY
Last Name:MELLENDORF
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 BAXMAN RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2657
Mailing Address - Country:US
Mailing Address - Phone:989-529-0746
Mailing Address - Fax:
Practice Address - Street 1:4917 BAXMAN RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2657
Practice Address - Country:US
Practice Address - Phone:989-529-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002044101YS0200X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool