Provider Demographics
NPI:1336819606
Name:BUDNIK, MELINDA SHEA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SHEA
Last Name:BUDNIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70655-2003
Mailing Address - Country:US
Mailing Address - Phone:337-639-3562
Mailing Address - Fax:337-639-4342
Practice Address - Street 1:1111 W SEVENTH AVE
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:LA
Practice Address - Zip Code:70655-6102
Practice Address - Country:US
Practice Address - Phone:337-639-3562
Practice Address - Fax:337-639-4342
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical