Healthcare Provider Details

I. General information

NPI: 1619805041
Provider Name (Legal Business Name): MELANIE FORD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 WESTPARK CTR DR STE 100
FENTON MO
63026-1916
US

IV. Provider business mailing address

1009 CLAYTONIA TER UNIT 1
RICHMOND HEIGHTS MO
63117-1508
US

V. Phone/Fax

Practice location:
  • Phone: 636-600-0446
  • Fax:
Mailing address:
  • Phone: 314-560-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: