MEDICARE: MELISSA GENREAU LMHC PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376168799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA GENREAU LMHC PLLC

Provider Business Mailing Address
First Line	:	373 COLLINS RD NE STE 200
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3167
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	373 COLLINS RD NE STE 200
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-3167
Country	:	US
Telephone Number	:	715-566-1494
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA GENDREAU
Credential	:
Telephone Number	:	715-566-1494

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	06/11/2020

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