Provider Demographics
NPI:1669642021
Name:MELLIN, ALISON ELIZABETH (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:ELIZABETH
Last Name:MELLIN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 SELBY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1880
Mailing Address - Country:US
Mailing Address - Phone:651-247-4822
Mailing Address - Fax:
Practice Address - Street 1:366 SELBY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1880
Practice Address - Country:US
Practice Address - Phone:651-247-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4177103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist