Provider Demographics
NPI:1023844735
Name:WILLIAMS, MELANIE LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 S LAKE GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-4065
Mailing Address - Country:US
Mailing Address - Phone:413-717-5984
Mailing Address - Fax:
Practice Address - Street 1:1328 W DRAGOON TRL
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-4713
Practice Address - Country:US
Practice Address - Phone:574-626-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99127207A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical