Provider Demographics
NPI:1487793998
Name:PREVO, MELISSA HOLLY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:HOLLY
Last Name:PREVO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 BAYSHORE BLVD.
Mailing Address - Street 2:6 MDOS/SGOH MENTAL HEALTH
Mailing Address - City:MACDILL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:33621-1607
Mailing Address - Country:US
Mailing Address - Phone:813-827-9170
Mailing Address - Fax:
Practice Address - Street 1:8415 BAYSHORE BLVD.
Practice Address - Street 2:6 MDOS/SGOH MENTAL HEALTH
Practice Address - City:MACDILL AFB
Practice Address - State:FL
Practice Address - Zip Code:33621-1607
Practice Address - Country:US
Practice Address - Phone:813-827-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical