Provider Demographics
NPI:1679820559
Name:MCCLELLAN, MELANIE K (IMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 BAYCROFT DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7109
Mailing Address - Country:US
Mailing Address - Phone:614-306-3021
Mailing Address - Fax:
Practice Address - Street 1:6135 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-9005
Practice Address - Country:US
Practice Address - Phone:614-389-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.0900009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist