Provider Demographics
NPI:1205197944
Name:MCDERMOTT, MELANIE MCCLISH (LMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MCCLISH
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 ROSEMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1538
Mailing Address - Country:US
Mailing Address - Phone:502-439-2969
Mailing Address - Fax:
Practice Address - Street 1:3415 BARDSTOWN RD STE 209A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4630
Practice Address - Country:US
Practice Address - Phone:502-439-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist