Provider Demographics
NPI:1568543270
Name:PORTER, MELANIE K (PSYD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
Last Name:PORTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 KENYON ROAD
Mailing Address - Street 2:NORTH CENTRAL IOWA MENTAL HEALTH DBA BERRYHILL CENTER
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:515-955-7171
Mailing Address - Fax:515-573-7898
Practice Address - Street 1:720 KENYON ROAD
Practice Address - Street 2:NORTH CENTRAL IOWA MENTAL HEALTH DBA BERRYHILL CENTER
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5759
Practice Address - Country:US
Practice Address - Phone:515-955-7171
Practice Address - Fax:515-573-7898
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07466OtherWELLMARK BC/BS
IA0159608Medicaid
IA242712OtherMIDLANDS CHOICE
IA242712OtherMIDLANDS CHOICE
IA07466OtherWELLMARK BC/BS