Healthcare Provider Details

I. General information

NPI: 1013341312
Provider Name (Legal Business Name): MELANIE LYNN JESSEL L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 HOSPITAL RD
NEWNAN GA
30263-1209
US

IV. Provider business mailing address

59 HOSPITAL RD
NEWNAN GA
30263-1209
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-4610
  • Fax:
Mailing address:
  • Phone: 678-423-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008706
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: