DR. MICHAEL JACK MELLOTT (NPI# 1760546147) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760546147 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL JACK MELLOTT |
| Credential | ED.D. |
| Practice Address |
3509 S Dylan St Flagstaff AZ 86001-9137 |
| Practice Telephone | 9287744658 |
| Practice Fax Number | 9287744658 |
| Mailing Telephone | 9287744658 |
| Mailing Fax Number | 9287744658 |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TS0200X |
Psychologist Specialization: School |
3598 | AZ | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AHCCCS PROVIDER NUMBER | 913039 | 01 |
| Street Address |
3509 S DYLAN ST |
| City | FLAGSTAFF |
| State | AZ |
| Zip Code | 86001-9137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578623484 | Ramona N Mellott | Psychologist | 3509 S Dylan St, Flagstaff, AZ 86001-9137 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658756 | Marlenne Adair Escobar-mendoza | Specialist/Technologist | 1705 South San Francisco Street, Flagstaff, AZ 86001 | 2020-10-27 |
| 1962033712 | Laura-lee Prescott | Social Worker | Northern Az Va Healthcare System, Flagstaff Cboc, 1300 W. University Ave., Suite 300, Flagstaff, AZ 86001 | 2020-01-30 |
| 1194360784 | Trinity Medical Consultants Pllc | Internal Medicine | 1521 N Cliff Drive, Flagstaff, AZ 86001 | 2019-11-07 |
| 1154849610 | Altacare, LLC | Family Medicine | 2700 S Woodlands Village Blvd Ste 700, Flagstaff, AZ 86001 | 2017-09-05 |
| 1487174926 | Lindsey Marie Forstie | Nurse Practitioner | 7263 E Dreamview Trail, Flagstaff, AZ 86001 | 2017-06-26 |
| 1255860763 | Welbrook Senior Living Flagstaff LLC | Skilled Nursing Facility | 1521 N Pine Cliff Dr, Flagstaff, AZ 86001 | 2017-06-08 |
| 1912432675 | Ryan Tiscareno | Specialist/Technologist | 621 West Cherry Ave, Flagstaff, AZ 86001 | 2017-05-01 |
| 1629432380 | Behavioral Consultation Services, Inc. | Clinic/Center | 345 S. River Run Road, Suite 200, Flagstaff, AZ 86001 | 2016-04-08 |
| 1275920928 | Junli Gallagher | Speech-Language Pathologist | 1215 N. Beaver St, Flagstaff, AZ 86001 | 2015-04-21 |
| 1932592599 | Kristen Flugstad Psyd, LLC | Psychologist | 125 East Elm Avenue #203, Flagstaff, AZ 86001 | 2015-03-06 |
| Find all providers in zip 86001 | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225229818 | Ronald T Johnson Jr. | Psychologist | 4000 N Lausanne Way, Flagstaff, AZ 86004-6832 | 2007-08-07 |
| 1457573362 | Jennifer Pritchard | Psychologist | 4000 N. Cummings, Flagstaff, AZ 86004 | 2007-05-02 |
| 1578780532 | Elizabeth Mary Mills | Psychologist | 10075 Mountainaire Rd, Flagstaff, AZ 86001-9586 | 2007-04-19 |
| 1265658330 | Marlene Hartmann | Psychologist | 2350 N Elk Run St, Flagstaff, AZ 86004-7603 | 2007-04-17 |
| 1376691899 | Anslem Gene Yazzie | Psychologist | 119 S Spring St, Flagstaff, AZ 86001-4472 | 2007-01-08 |
| 1447550371 | Lindsey Peterson | Psychologist | 3223 N 4th St, Flagstaff, AZ 86004-2039 | 2010-10-26 |
| 1598081010 | Nancy Marie Evans | Psychologist | 3285 E Sparrow Ave, Flagstaff, AZ 86004-7794 | 2010-04-08 |
| 1659529741 | Cynthia Mattern | Psychologist | 3285 E Sparrow Ave, Flagstaff, AZ 86004-7794 | 2008-09-03 |
| 1447440201 | Lee W Lusk | Psychologist | 710 N. Beaver Street, Bldg 4, Flagstaff, AZ 86001-3139 | 2007-07-27 |
| 1174736011 | Dina Neuberger | Psychologist | 3285 E Sparrow Ave, Flagstaff, AZ 86004-7794 | 2007-05-08 |
| Find all providers in FLAGSTAFF | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.