Provider Demographics
NPI:1982786695
Name:MELVIN CANELL ED D
Entity Type:Organization
Organization Name:MELVIN CANELL ED D
Other - Org Name:AFFILLIATES IN PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-534-7170
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-0892
Mailing Address - Country:US
Mailing Address - Phone:308-534-7170
Mailing Address - Fax:308-534-2377
Practice Address - Street 1:1510 E 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4304
Practice Address - Country:US
Practice Address - Phone:308-534-7170
Practice Address - Fax:308-534-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE212944723251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE259226000OtherMAGELLAN MIS
NE212944723OtherSTATE OF NE ID
NEA937805OtherVALUE OPTIONS
NE212944723OtherSTATE OF NE ID
NE259226000OtherMAGELLAN MIS