Individual
MICHAEL W MELLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3333 BURNET AVENUE, ML 5021, CINCINNATI, OH 45229-3039
(513) 636-4225
(513) 636-2511
Mailing address
3333 BURNET AVENUE, ML 3015, CINCINNATI, OH 45229-3039
(513) 636-4336
(513) 636-3677
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6611
OH
103TC2200X
Clinical Child & Adolescent Psychologist
LP4195
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680011889
RAILROAD MEDICARE
MN
05
—
811579600
—
MN
Enumeration date
01/25/2006
Last updated
03/31/2010
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