Active NPI
Melonia Sue Russell, LMFT
- Marriage & Family Therapist
- Elkhart, IN
National Provider Identifier
1306032875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 35001623A
- Practice address
- 1400 W Indiana Ave
Elkhart, IN 46516-2164 - Phone
- (546) 276-3775
- NPI assigned
- Sep 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 35001623A | IN | Primary |
Addresses
Primary practice location
1400 W Indiana Ave
Elkhart, IN 46516-2164
Mailing address
PO Box 462
Bremen, IN 46506-0462
Phone (574) 276-3775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35001623A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1306032875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 462",
"city": "BREMEN",
"state": "IN",
"postal_code": "465060462",
"telephone_number": "574-276-3775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 W INDIANA AVE",
"city": "ELKHART",
"state": "IN",
"postal_code": "465162164",
"telephone_number": "546-276-3775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "MELONIA",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "35001623A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.