Provider Demographics
NPI:1902441652
Name:HILL, MELINDA GAYLE (BA, PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:GAYLE
Last Name:HILL
Suffix:
Gender:F
Credentials:BA, PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3815
Mailing Address - Country:US
Mailing Address - Phone:318-861-8938
Mailing Address - Fax:318-862-3554
Practice Address - Street 1:1513 LINE AVENUE
Practice Address - Street 2:SUITE 225
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-754-3890
Practice Address - Fax:318-658-9012
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty