Provider Demographics
NPI:1184773665
Name:MELCHER, CHARLOTTE R (PHD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:R
Last Name:MELCHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 SCENICVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1441
Mailing Address - Country:US
Mailing Address - Phone:859-223-1141
Mailing Address - Fax:859-223-0421
Practice Address - Street 1:704 SPRING MEADOWS DR
Practice Address - Street 2:SUITE A
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3624
Practice Address - Country:US
Practice Address - Phone:859-277-0667
Practice Address - Fax:859-223-0421
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0740103TH0100X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000068811OtherANTHEM PROVIDER NUMBER
KYCP00136Medicare PIN