Healthcare Provider Details

I. General information

NPI: 1598805418
Provider Name (Legal Business Name): SUSAN E MELCHER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MICHAEL LN
WATERVILLE ME
04901-5840
US

IV. Provider business mailing address

62 FAYETTE RD
LIVERMORE FALLS ME
04254-4106
US

V. Phone/Fax

Practice location:
  • Phone: 207-680-2065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC3210
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: