Provider Demographics
NPI:1740361625
Name:MINTEER, MELANIE D (LMFT)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:D
Last Name:MINTEER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 GIRARD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4464
Mailing Address - Country:US
Mailing Address - Phone:502-802-1319
Mailing Address - Fax:502-412-8176
Practice Address - Street 1:2210 GOLDSMITH LN
Practice Address - Street 2:STE 201B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1038
Practice Address - Country:US
Practice Address - Phone:502-385-0093
Practice Address - Fax:502-412-8176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0589OtherLMFT, LEGACY LICENSE NUMBER
KY105590OtherLMFT