Basic Information
| Provider Information | |||||||||
| NPI: | 1912285552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLEP | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC, LLMFT, NCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WHEELER | ||||||||
| OtherFirstName: | MELANIE | ||||||||
| OtherMiddleName: | JOY | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12366 BURLINGAME DR | ||||||||
| Address2: | |||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488209300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104947180 | ||||||||
| FaxNumber: | 5179935476 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 E MOUNT HOPE AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489103262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179935474 | ||||||||
| FaxNumber: | 5179935476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2011 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401011092 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 4101006409 | MI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.