Provider Demographics
NPI:1881708378
Name:PAPINEAU, MELISSA MOHON (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MOHON
Last Name:PAPINEAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:S
Other - Last Name:MOHON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8100 E 22ND ST N
Mailing Address - Street 2:BLDG 100, STE.2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2388
Mailing Address - Country:US
Mailing Address - Phone:316-337-5451
Mailing Address - Fax:316-337-5481
Practice Address - Street 1:8100 E 22ND ST N
Practice Address - Street 2:BLDG 100, STE.2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-337-5451
Practice Address - Fax:316-337-5481
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP-0560103T00000X, 103TB0200X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS066524Medicare ID - Type Unspecified