Provider Demographics
NPI:1568865459
Name:MELBY, PAUL ERIC (MS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ERIC
Last Name:MELBY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12295 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-4416
Mailing Address - Country:US
Mailing Address - Phone:612-799-8532
Mailing Address - Fax:
Practice Address - Street 1:12295 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-4416
Practice Address - Country:US
Practice Address - Phone:612-799-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health