Provider Demographics
NPI:1548514136
Name:MINELLI, KATELYN J (MMFT)
Entity type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:J
Last Name:MINELLI
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 N HAPPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9523
Mailing Address - Country:US
Mailing Address - Phone:574-538-9760
Mailing Address - Fax:
Practice Address - Street 1:1136 W 17TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3002
Practice Address - Country:US
Practice Address - Phone:812-929-2193
Practice Address - Fax:888-789-8394
Is Sole Proprietor?:No
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist