Healthcare Provider Details

I. General information

NPI: 1366068751
Provider Name (Legal Business Name): MELISSA ERIN HERR LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ERIN JOHNSON

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 BRADENTON AVE STE D
DUBLIN OH
43017-3511
US

IV. Provider business mailing address

2 EASTON OVAL STE 450
COLUMBUS OH
43219-6035
US

V. Phone/Fax

Practice location:
  • Phone: 614-475-9500
  • Fax: 614-475-9821
Mailing address:
  • Phone: 614-475-9500
  • Fax: 614-475-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2001767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: