Provider Demographics
NPI:1043831977
Name:MELLO, ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MELLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SANDPIPER AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2918
Mailing Address - Country:US
Mailing Address - Phone:561-722-4850
Mailing Address - Fax:
Practice Address - Street 1:1920 PALM BEACH LAKES BLVD STE 211
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3506
Practice Address - Country:US
Practice Address - Phone:561-721-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health