Provider Demographics
NPI:1578623484
Name:MELLOTT, RAMONA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAMONA
Middle Name:N
Last Name:MELLOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 S DYLAN ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9137
Mailing Address - Country:US
Mailing Address - Phone:928-774-4658
Mailing Address - Fax:928-523-9284
Practice Address - Street 1:3509 S DYLAN ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9137
Practice Address - Country:US
Practice Address - Phone:928-774-4658
Practice Address - Fax:928-523-9284
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist