Provider Demographics
NPI:1104198902
Name:MELANIE A JARRELL, LCSW,PLLC
Entity Type:Organization
Organization Name:MELANIE A JARRELL, LCSW,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-609-0062
Mailing Address - Street 1:3401 SASSE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-8514
Mailing Address - Country:US
Mailing Address - Phone:502-609-0062
Mailing Address - Fax:
Practice Address - Street 1:3401 SASSE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-8514
Practice Address - Country:US
Practice Address - Phone:502-609-0062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3213251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health