Healthcare Provider Details

I. General information

NPI: 1285461640
Provider Name (Legal Business Name): MELANIE MAYS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 LEONARD ST NW STE G
GRAND RAPIDS MI
49504-4260
US

IV. Provider business mailing address

8112 WHIP POR WIL WAY NE
ROCKFORD MI
49341-7009
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-6874
  • Fax:
Mailing address:
  • Phone: 406-370-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222650
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: