Basic Information
| Provider Information | |||||||||
| NPI: | 1134641137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDITT | ||||||||
| FirstName: | MELINI | ||||||||
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| Credential: | PLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5440 C MLK PKWY | ||||||||
| Address2: | P.O. BOX 101 | ||||||||
| City: | CARVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70721 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3173 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257787678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2017 | ||||||||
| LastUpdateDate: | 05/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.