Healthcare Provider Details

I. General information

NPI: 1235623562
Provider Name (Legal Business Name): MELISSA VALERIE TAYLOR MA, PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSYCHOLOGICAL SERVICES OF ST LOUIS, LLC 7110 OAKLAND AVE
ST LOUIS MO
63117
US

IV. Provider business mailing address

4249 CHOUTEAU AVE
SAINT LOUIS MO
63110-1753
US

V. Phone/Fax

Practice location:
  • Phone: 314-403-2031
  • Fax:
Mailing address:
  • Phone: 314-403-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: