Provider Demographics
NPI:1942666961
Name:MELLROY, ADRIENNE JILL
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:JILL
Last Name:MELLROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W US HIGHWAY 54
Mailing Address - Street 2:PO BOX 986
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-6945
Mailing Address - Country:US
Mailing Address - Phone:573-317-9061
Mailing Address - Fax:573-317-1970
Practice Address - Street 1:106 W US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6945
Practice Address - Country:US
Practice Address - Phone:573-317-9061
Practice Address - Fax:573-317-1970
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor