Healthcare Provider Details

I. General information

NPI: 1750563607
Provider Name (Legal Business Name): MELISSA LYNN MELOY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/06/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 OLD BUSINESS HWY 60
VAN BUREN MO
63965-9700
US

IV. Provider business mailing address

1011 OLD BUSINESS HWY 60
VAN BUREN MO
63965-9700
US

V. Phone/Fax

Practice location:
  • Phone: 573-323-2171
  • Fax:
Mailing address:
  • Phone: 573-323-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007035130
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: