Provider Demographics
NPI:1275263493
Name:MELLIS, HEATHER (MFT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MELLIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 MADISON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-3219
Mailing Address - Country:US
Mailing Address - Phone:513-813-6718
Mailing Address - Fax:
Practice Address - Street 1:2010 MADISON RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-3219
Practice Address - Country:US
Practice Address - Phone:513-813-6718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty