Provider Demographics
NPI:1992998603
Name:VILLALON, MELISSA ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:VILLALON
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:PO BOX 179302
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-8302
Mailing Address - Country:US
Mailing Address - Phone:808-291-1772
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR STE 203
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-291-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI996103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic