Provider Demographics
NPI:1619594025
Name:MELLA MUSIC THERAPY LLC
Entity Type:Organization
Organization Name:MELLA MUSIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:P
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:480-834-7049
Mailing Address - Street 1:761 E UNIVERSITY DR STE E
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-7961
Mailing Address - Country:US
Mailing Address - Phone:480-834-7049
Mailing Address - Fax:
Practice Address - Street 1:761 E UNIVERSITY DR STE E
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-7961
Practice Address - Country:US
Practice Address - Phone:480-834-7049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty