Provider Demographics
NPI:1346642188
Name:MELLOTT, NATHAN (LSW;MSW)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:MELLOTT
Suffix:
Gender:M
Credentials:LSW;MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E CLAY ST. BOX 41
Mailing Address - Street 2:
Mailing Address - City:MT. BLANCHARD
Mailing Address - State:OH
Mailing Address - Zip Code:45867
Mailing Address - Country:US
Mailing Address - Phone:419-306-8415
Mailing Address - Fax:
Practice Address - Street 1:1918 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3818
Practice Address - Country:US
Practice Address - Phone:419-425-5050
Practice Address - Fax:419-423-7854
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional