Provider Demographics
NPI:1073810305
Name:MELTON, KRISTEN MICHELLE
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:MELTON
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 1:2920 S JONES BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5395
Mailing Address - Country:US
Mailing Address - Phone:702-806-5268
Mailing Address - Fax:702-485-1107
Practice Address - Street 1:2920 S JONES BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5395
Practice Address - Country:US
Practice Address - Phone:702-806-5268
Practice Address - Fax:702-485-1107
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist