MEDICARE: MELISSA TERRY LPC, CAADC

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	101YM0800X	Mental Health Counselor	4101006363	MI

General Provider Information

NPI Number	:	1558693911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA TERRY LPC, CAADC

Provider Business Mailing Address
First Line	:	812 E JOLLY RD STE 215
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-6821
Country	:	US
Telephone Number	:	517-346-8462
Fax Number	:	517-346-8432

Provider Business Practice Location Address
First Line	:	812 E JOLLY RD STE 215
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-6821
Country	:	US
Telephone Number	:	517-346-8462
Fax Number	:	517-346-8432

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

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/06/2015

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