Provider Demographics
NPI:1043695109
Name:KORLAND, MELISSA (PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KORLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 VALENCIA CIR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1562
Mailing Address - Country:US
Mailing Address - Phone:216-464-4177
Mailing Address - Fax:
Practice Address - Street 1:3659 GREEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5727
Practice Address - Country:US
Practice Address - Phone:216-978-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical