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NPI Code Detail

MEDICARE: MELISSA LUKE GONZALEZ PH.D.

MEDICARE: MELISSA LUKE GONZALEZ PH.D.
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
1103TM1800XIntellectual & Developmental Disabilities Psychologist04898MD
2103TM1800XIntellectual & Developmental Disabilities Psychologist1430LA

General Provider Information

NPI Number : 1447563044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA LUKE GONZALEZ PH.D.
Provider Business Mailing Address
First Line : 1101 CARTER ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-5017
Country : US
Telephone Number : 423-490-7710
Fax Number : 423-490-7750
Provider Business Practice Location Address
First Line : 1101 CARTER ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-5017
Country : US
Telephone Number : 423-490-7710
Fax Number : 423-490-7750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2010
Last Update Date : 04/24/2020

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