Provider Demographics
NPI:1770080079
Name:BALLEIN, MELANIE ANN (LICDC, LSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:BALLEIN
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6480 WELCOME RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-6992
Mailing Address - Country:US
Mailing Address - Phone:937-763-5411
Mailing Address - Fax:
Practice Address - Street 1:149 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-0296
Practice Address - Country:US
Practice Address - Phone:937-393-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005190104100000X
OHLICDC.162486101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker