Provider Demographics
NPI:1164150751
Name:MELTON TELEPSYCHIATRY SERVICES
Entity Type:Organization
Organization Name:MELTON TELEPSYCHIATRY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:901-212-4314
Mailing Address - Street 1:6181 OLD MILLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-7439
Mailing Address - Country:US
Mailing Address - Phone:901-800-9159
Mailing Address - Fax:877-800-9150
Practice Address - Street 1:6181 OLD MILLINGTON RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-7439
Practice Address - Country:US
Practice Address - Phone:901-800-9159
Practice Address - Fax:877-800-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty