Provider Demographics
NPI:1922201755
Name:CASSULO, MELANIE (LMHC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:CASSULO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 HARBOR PL SW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-6504
Mailing Address - Country:US
Mailing Address - Phone:850-368-4113
Mailing Address - Fax:850-837-0104
Practice Address - Street 1:3997 COMMONS DR W STE C
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8444
Practice Address - Country:US
Practice Address - Phone:850-368-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health