Healthcare Provider Details

I. General information

NPI: 1619612306
Provider Name (Legal Business Name): MELISSA ANN BARTSCH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EASTERN KENTUCKY UNIVERSITY COUNSELING CENTER 521 LANCASTER AVE., WHITLOCK 571
RICHMOND KY
40475-4047
US

IV. Provider business mailing address

4757 FOXGLOVE PT
LEXINGTON KY
40509-8018
US

V. Phone/Fax

Practice location:
  • Phone: 859-622-1303
  • Fax:
Mailing address:
  • Phone: 865-591-9724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2619
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number168021
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: