Provider Demographics
NPI:1174060123
Name:ALABA, MELANIE L
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:L
Last Name:ALABA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:L
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13675 COURSEY BLVD APT 215
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1346
Mailing Address - Country:US
Mailing Address - Phone:225-394-0208
Mailing Address - Fax:
Practice Address - Street 1:4021 WE HECK CT STE 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0416
Practice Address - Country:US
Practice Address - Phone:225-302-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator