Provider Demographics
NPI:1063632693
Name:FRENCH, MELVIN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:L
Last Name:FRENCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 CLARKSON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2497
Mailing Address - Country:US
Mailing Address - Phone:636-256-0600
Mailing Address - Fax:636-256-0626
Practice Address - Street 1:249 CLARKSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2497
Practice Address - Country:US
Practice Address - Phone:636-256-0600
Practice Address - Fax:636-256-0626
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015689103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3156Medicare PIN
057-72023OtherBC/BS