Basic Information
| Provider Information | |||||||||
| NPI: | 1043465917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MELLUPS | ||||||||
| FirstName: | KIRA | ||||||||
| MiddleName: | KRISTEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26630 BARTON RD | ||||||||
| Address2: | #715 | ||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923734323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097477616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 411 OAK ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008525678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY21787 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.