Provider Demographics
NPI:1457572984
Name:MELROSE, PAUL J (LMFT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:MELROSE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MONONA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3554
Mailing Address - Country:US
Mailing Address - Phone:608-663-0763
Mailing Address - Fax:608-663-0765
Practice Address - Street 1:5900 MONONA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3554
Practice Address - Country:US
Practice Address - Phone:608-663-0763
Practice Address - Fax:608-663-0765
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006221106H00000X
WI1026-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist