Healthcare Provider Details

I. General information

NPI: 1043586951
Provider Name (Legal Business Name): MELISSA ANN EHART LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2012
Last Update Date: 03/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S WESTNEDGE AVE
KALAMAZOO MI
49008-1166
US

IV. Provider business mailing address

104 N 22ND ST
BATTLE CREEK MI
49015-1763
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4458
  • Fax:
Mailing address:
  • Phone: 269-968-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012045
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: