Provider Demographics
NPI:1891448783
Name:MELANATED MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:MELANATED MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:NECOLE
Authorized Official - Last Name:DESAUSSURE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:407-961-9863
Mailing Address - Street 1:1630 CALLIE CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1567
Mailing Address - Country:US
Mailing Address - Phone:407-961-9863
Mailing Address - Fax:
Practice Address - Street 1:1630 CALLIE CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1567
Practice Address - Country:US
Practice Address - Phone:407-961-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)