Provider Demographics
NPI:1396586426
Name:KELLAM, MELANIE DENISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DENISE
Last Name:KELLAM
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 1:135 BREEZEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BROOKELAND
Mailing Address - State:TX
Mailing Address - Zip Code:75931-0008
Mailing Address - Country:US
Mailing Address - Phone:936-635-5205
Mailing Address - Fax:
Practice Address - Street 1:135 BREEZEWAY DR
Practice Address - Street 2:
Practice Address - City:BROOKELAND
Practice Address - State:TX
Practice Address - Zip Code:75931-0008
Practice Address - Country:US
Practice Address - Phone:936-635-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3064103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist