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General NPI Number Information
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NPI Number | 1013538834
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Entity Type | Individual
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Provider Name | MELISSA MARGO BLACK MSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 3475 BELLE CHASE WAY
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City | LANSING
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State | MI
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Zip | 48911-4252
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Country | US
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Telephone | 517-882-3732
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Fax |
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Provider Business Mailing Address
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Address Line | 118 COWLEY AVE
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City | EAST LANSING
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State | MI
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Zip | 48823-4012
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Country | US
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Telephone | 517-897-2774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 4704292407
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704292407
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 4704292407
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License Number State | MI
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