Healthcare Provider Details

I. General information

NPI: 1679110910
Provider Name (Legal Business Name): MELANIE R DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE R HARRIS

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 CROSSWINDS CT
WENTZVILLE MO
63385-4836
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 888-403-1071
  • Fax: 636-332-9950
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2018041176
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: