Healthcare Provider Details

I. General information

NPI: 1831938117
Provider Name (Legal Business Name): MELISSA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300R E MAIN ST
CLARION PA
16214-1214
US

IV. Provider business mailing address

51 RAVEN LN
LUCINDA PA
16235-1139
US

V. Phone/Fax

Practice location:
  • Phone: 814-229-0188
  • Fax:
Mailing address:
  • Phone: 814-229-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC000046
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: