Provider Demographics
NPI:1750073995
Name:MELENDEZ HARRIS, GILLIAN (LMHC)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:MELENDEZ HARRIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-4310
Mailing Address - Country:US
Mailing Address - Phone:718-644-3948
Mailing Address - Fax:
Practice Address - Street 1:2624 NE 7TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-4310
Practice Address - Country:US
Practice Address - Phone:718-644-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health