Provider Demographics
NPI:1912732629
Name:KING, MELODY B (MS, LMHCA, LCACA)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:B
Last Name:KING
Suffix:
Gender:F
Credentials:MS, LMHCA, LCACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BRIARCLIFFE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3114
Mailing Address - Country:US
Mailing Address - Phone:219-378-8701
Mailing Address - Fax:
Practice Address - Street 1:7853 TAFT ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5240
Practice Address - Country:US
Practice Address - Phone:219-791-9083
Practice Address - Fax:219-791-9084
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87900102A101YA0400X
IN88002455A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)