Healthcare Provider Details

I. General information

NPI: 1972588283
Provider Name (Legal Business Name): MELISSA ANN COLTON NCC, LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 N RONALD REAGAN BLVD STE 116
LONGWOOD FL
32750-3534
US

IV. Provider business mailing address

2290 N RONALD REAGAN BLVD STE 116
LONGWOOD FL
32750-3534
US

V. Phone/Fax

Practice location:
  • Phone: 407-215-0095
  • Fax:
Mailing address:
  • Phone: 407-215-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001004968
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: