Provider Demographics
NPI:1205469020
Name:BRELAND, MELISSA ELIZABETH
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:BRELAND
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 1:285 S ROCHELLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-2924
Mailing Address - Country:US
Mailing Address - Phone:407-257-9217
Mailing Address - Fax:
Practice Address - Street 1:1216 PATRICK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5534
Practice Address - Country:US
Practice Address - Phone:407-257-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health