Individual
MELINA MARIE SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, HSPP
Contact information
Practice address
210 S RACE ST, MISHAWAKA, IN 46544-2032
(574) 404-6755
(833) 783-4269
Mailing address
2709 BLACKTAIL CT, SOUTH BEND, IN 46614-9168
(574) 274-8193
(833) 783-4269
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20043242A
IN
Other
Enumeration date
08/19/2019
Last updated
08/19/2019
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