Provider Demographics
NPI:1497466650
Name:MELNIK, LEE ANNE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANNE
Last Name:MELNIK
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 1:12953 WHITTINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1874
Mailing Address - Country:US
Mailing Address - Phone:727-458-6906
Mailing Address - Fax:
Practice Address - Street 1:13191 STARKEY RD STE 14
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1400
Practice Address - Country:US
Practice Address - Phone:727-458-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000013395101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor