Provider Demographics
NPI:1386052595
Name:MELECIO, NORELY
Entity type:Individual
Prefix:
First Name:NORELY
Middle Name:
Last Name:MELECIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 JOHN KING RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5772
Mailing Address - Country:US
Mailing Address - Phone:850-398-4155
Mailing Address - Fax:850-398-4142
Practice Address - Street 1:128 JOHN KING RD
Practice Address - Street 2:SUITE 14
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5772
Practice Address - Country:US
Practice Address - Phone:850-398-4155
Practice Address - Fax:850-398-4142
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health