Provider Demographics
NPI:1720491632
Name:NEAL, MELONDY JEANINE
Entity Type:Individual
Prefix:MS
First Name:MELONDY
Middle Name:JEANINE
Last Name:NEAL
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 1:7100 PLANTATION RD
Mailing Address - Street 2:SUITE # 11
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4206
Mailing Address - Country:US
Mailing Address - Phone:850-356-6776
Mailing Address - Fax:
Practice Address - Street 1:7100 PLANTATION RD
Practice Address - Street 2:SUITE # 11
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-356-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst