Provider Demographics
NPI:1780294587
Name:GRUNER, MELANIE HOWTON (DMIN, MDIV, CPE,)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:HOWTON
Last Name:GRUNER
Suffix:
Gender:F
Credentials:DMIN, MDIV, CPE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 OAKFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5871
Mailing Address - Country:US
Mailing Address - Phone:813-404-7214
Mailing Address - Fax:
Practice Address - Street 1:1403 OAKFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5871
Practice Address - Country:US
Practice Address - Phone:813-404-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty