Provider Demographics
NPI:1952447401
Name:MILLS, MELANIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OLIVETTE EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3252
Mailing Address - Country:US
Mailing Address - Phone:314-432-6200
Mailing Address - Fax:314-432-3059
Practice Address - Street 1:1101 OLIVETTE EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3252
Practice Address - Country:US
Practice Address - Phone:314-432-6200
Practice Address - Fax:314-432-3059
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040346581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical