Provider Demographics
NPI:1841187317
Name:MELINICH, BRANDIS LUCILLE
Entity type:Individual
Prefix:
First Name:BRANDIS
Middle Name:LUCILLE
Last Name:MELINICH
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 1:2109 MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-2809
Mailing Address - Country:US
Mailing Address - Phone:937-397-7002
Mailing Address - Fax:
Practice Address - Street 1:2109 MAYFLOWER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-2809
Practice Address - Country:US
Practice Address - Phone:937-397-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2506858-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor