Provider Demographics
NPI:1659776011
Name:ZWISSLER, MEL MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:MICHAEL
Last Name:ZWISSLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8706 GLENCANYON DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9269
Mailing Address - Country:US
Mailing Address - Phone:614-406-6020
Mailing Address - Fax:
Practice Address - Street 1:8706 GLENCANYON DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9269
Practice Address - Country:US
Practice Address - Phone:614-406-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical