Provider Demographics
NPI:1316458649
Name:KATHERINE A MELCHIOR PHD LLC
Entity type:Organization
Organization Name:KATHERINE A MELCHIOR PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:MELCHIOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-589-3048
Mailing Address - Street 1:2241 MUMFORD RD
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9309
Mailing Address - Country:US
Mailing Address - Phone:734-589-3048
Mailing Address - Fax:
Practice Address - Street 1:19855 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2022
Practice Address - Country:US
Practice Address - Phone:734-589-3048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014731103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty