Provider Demographics
NPI:1497907398
Name:BYNUM, MELODY (MA)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BYNUM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 VIOLA FARMS DR
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-3104
Mailing Address - Country:US
Mailing Address - Phone:225-663-9083
Mailing Address - Fax:
Practice Address - Street 1:2100 ORY DR
Practice Address - Street 2:
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70719-2459
Practice Address - Country:US
Practice Address - Phone:720-476-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator