Provider Demographics
NPI:1275323453
Name:MELVILLE, KALEY
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 LIVE OAK ST OFC 1
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1553
Mailing Address - Country:US
Mailing Address - Phone:386-222-3011
Mailing Address - Fax:
Practice Address - Street 1:509 LIVE OAK ST OFC 1
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1553
Practice Address - Country:US
Practice Address - Phone:386-222-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty