MEDICARE: MS. MELINDA G HIGGINBOTHAM MS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1207	AL

General Provider Information

NPI Number	:	1225297351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA G HIGGINBOTHAM MS LPC

Provider Business Mailing Address
First Line	:	3104 BLUE LAKE DRIVE
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243
Country	:	US
Telephone Number	:	205-977-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 BLUE LAKE DR
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2345
Country	:	US
Telephone Number	:	205-977-3003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	06/04/2008

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