Provider Demographics
NPI:1497291462
Name:MELANCION, ALLYNNIKA
Entity Type:Individual
Prefix:
First Name:ALLYNNIKA
Middle Name:
Last Name:MELANCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 HISTORIC WEST ST
Mailing Address - Street 2:
Mailing Address - City:GARYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70051-3208
Mailing Address - Country:US
Mailing Address - Phone:985-224-9492
Mailing Address - Fax:
Practice Address - Street 1:188 HISTORIC WEST ST
Practice Address - Street 2:
Practice Address - City:GARYVILLE
Practice Address - State:LA
Practice Address - Zip Code:70051-3208
Practice Address - Country:US
Practice Address - Phone:985-224-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health