Provider Demographics
NPI:1922389543
Name:VINCENT, MELYNDA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELYNDA
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1055
Mailing Address - Country:US
Mailing Address - Phone:801-604-5342
Mailing Address - Fax:
Practice Address - Street 1:601 E VALLEY DR
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1055
Practice Address - Country:US
Practice Address - Phone:801-604-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker