Provider Demographics
NPI:1972783405
Name:MELLIES, ERIN NICHOLE (LCPC, LCAC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICHOLE
Last Name:MELLIES
Suffix:
Gender:F
Credentials:LCPC, LCAC
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:NICHOLE
Other - Last Name:ENNEKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:535 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-2504
Mailing Address - Country:US
Mailing Address - Phone:785-447-3871
Mailing Address - Fax:
Practice Address - Street 1:535 COURT ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-2504
Practice Address - Country:US
Practice Address - Phone:785-447-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCAC00791101YA0400X
KSLCPC03203101YP2500X, 101YP2500X, 101YP2500X
KSLCLC03203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)