Provider Demographics
NPI:1306038435
Name:FLUELLEN, MELANIE ELAINE (PCC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELAINE
Last Name:FLUELLEN
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ELAINE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 715194
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5194
Mailing Address - Country:US
Mailing Address - Phone:614-355-8004
Mailing Address - Fax:614-355-0509
Practice Address - Street 1:655 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2618
Practice Address - Country:US
Practice Address - Phone:614-722-8209
Practice Address - Fax:614-722-8422
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600522-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare PIN