Individual
JACQUELYN M MELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2634 HWY 109, SUITE E, WILDWOOD, MO 63040
(314) 384-6534
(636) 274-9332
Mailing address
8534 SAGAMORE DR., CEDAR HILL, MO 63016
(636) 288-9737
(636) 274-9332
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
001252
MO
Other
Enumeration date
04/01/2020
Last updated
04/20/2020
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