Individual
MELODY M MORTENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4241 N GABEL DR STE 2B, FAYETTEVILLE, AR 72703-5296
(479) 879-2115
(479) 249-6989
Mailing address
PO BOX 555, FAYETTEVILLE, AR 72702-0555
(479) 879-2115
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2551-C
AR
Other
Enumeration date
08/25/2011
Last updated
10/01/2019
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