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Contact Information

JACQUELYN M MELLIS, LCSW
2634 HWY 109
SUITE E
WILDWOOD, MO63040
 Phone: 314-384-6534
 Fax: 636-274-9332
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
Indicates primary specialty

NPI Profile & details for JACQUELYN M MELLIS · (Female)

NPI # 1154959336
Status Active
Credentials LCSW (Licensed Clinical Social Worker)
Entity Individual
Enumeration date 04/01/2020
Last updated 04/20/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • MO License # 001252
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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