Provider Demographics
NPI:1417394107
Name:BRECHT, MELINDA SUSAN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:SUSAN
Last Name:BRECHT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:S
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:2520 SAND MINE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897
Mailing Address - Country:US
Mailing Address - Phone:407-910-2941
Mailing Address - Fax:
Practice Address - Street 1:2520 SAND MINE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-3402
Practice Address - Country:US
Practice Address - Phone:407-910-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13617101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019386800Medicaid