Provider Demographics
NPI:1851897805
Name:ALI, MELINDA MATULIS (LSW, CSW-I)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MATULIS
Last Name:ALI
Suffix:
Gender:F
Credentials:LSW, CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 SPENCER ST STE 118
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5250
Mailing Address - Country:US
Mailing Address - Phone:702-799-9710
Mailing Address - Fax:
Practice Address - Street 1:4055 SPENCER ST STE 118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5250
Practice Address - Country:US
Practice Address - Phone:702-799-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-15191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical