Provider Demographics
NPI:1821129305
Name:MCMELLEN, MICHELLE M (MA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:MCMELLEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 S JAMES ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2166
Mailing Address - Country:US
Mailing Address - Phone:231-845-2900
Mailing Address - Fax:231-845-2905
Practice Address - Street 1:101 S JAMES ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2166
Practice Address - Country:US
Practice Address - Phone:231-845-2900
Practice Address - Fax:231-845-2905
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007890103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical