Provider Demographics
NPI:1073999835
Name:HARRELL, MELODY (LCSW)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PLAZA EAST BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2871
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:
Practice Address - Street 1:101 PLAZA EAST BLVD STE 303
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2871
Practice Address - Country:US
Practice Address - Phone:812-491-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007102A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical