Healthcare Provider Details

I. General information

NPI: 1962619809
Provider Name (Legal Business Name): MELISSA MARIE KLEINSCHMIDT MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 BERRYWOOD DR
COLUMBIA MO
65201-8372
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-7530
  • Fax:
Mailing address:
  • Phone: 417-751-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2005029326
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: