Mellott, Michael Jack

Mellott, Michael Jack is an sole proprietor health care provider with primary practice located at 3509 S Dylan St , Flagstaff AZ 86001-9137. He recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as his primary health care specialty. Mellott, Michael Jack can be contacted via phone (928) 774-4658.

Contact Information

Primary practice address
3509 S Dylan St Flagstaff AZ 86001-9137
Phone: (928) 774-4658
Fax: (928) 774-4658
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 103TS0200X 3598 Arizona

Profile Details

NPI number 1760546147
LBN Legal business name Mellott, Michael Jack
Credentials ED.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 20th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760546147 NPPES
Arizona Other 913039 AHCCCS PROVIDER NUMBER

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