Provider Demographics
NPI:1093373136
Name:MELIAN, AUTUMN VERSTEGAN (LPC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:VERSTEGAN
Last Name:MELIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:AUTUMN
Other - Middle Name:VERSTEGAN
Other - Last Name:EHLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13000 W BLUEMOUND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2650
Mailing Address - Country:US
Mailing Address - Phone:262-785-9188
Mailing Address - Fax:
Practice Address - Street 1:13000 W BLUEMOUND RD STE 300
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2650
Practice Address - Country:US
Practice Address - Phone:262-785-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WI8147125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional