Provider Demographics
NPI:1922208438
Name:MELLON, KIM LEIGH (LISW)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:LEIGH
Last Name:MELLON
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRAL OHIO MENTAL HEALTH CENTER.
Mailing Address - Street 2:250 SOUTH HENRY STREET
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2978
Mailing Address - Country:US
Mailing Address - Phone:740-369-7688
Mailing Address - Fax:740-363-4814
Practice Address - Street 1:CENTRAL OHIO MENTAL HEALTH CENTER.
Practice Address - Street 2:250 SOUTH HENRY STREET
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2978
Practice Address - Country:US
Practice Address - Phone:740-369-4482
Practice Address - Fax:740-336-9490
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 00083911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical