Provider Demographics
NPI:1164834032
Name:KLAUSNER, MELYNDA MILLARD (LCPC)
Entity type:Individual
Prefix:
First Name:MELYNDA
Middle Name:MILLARD
Last Name:KLAUSNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4134
Mailing Address - Country:US
Mailing Address - Phone:410-788-0300
Mailing Address - Fax:410-869-7244
Practice Address - Street 1:500 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4134
Practice Address - Country:US
Practice Address - Phone:410-788-0300
Practice Address - Fax:410-869-7244
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional