Healthcare Provider Details

I. General information

NPI: 1508729484
Provider Name (Legal Business Name): MELISSA MARY AYRE LMSW/C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 E COOK RD
GRAND BLANC MI
48439-8012
US

IV. Provider business mailing address

2216 E COOK RD
GRAND BLANC MI
48439-8012
US

V. Phone/Fax

Practice location:
  • Phone: 810-223-7486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118963
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: