Provider Demographics
NPI:1518263664
Name:KRIEG, MELANIE (LLP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KRIEG
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 HAZEN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-2008
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:
Practice Address - Street 1:801 HAZEN ST STE C
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-2008
Practice Address - Country:US
Practice Address - Phone:269-657-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014438103TB0200X
MI6401223439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral