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General NPI Number Information
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NPI Number | 1194182410
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Entity Type | Organization
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Legal Business Name | MELISSA WHITLOW LMHC
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Dates
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Enumeration Date | 01/16/2016
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 329 W ADELAIDE DR
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City | SAINT JOHNS
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State | FL
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Zip | 32259-6931
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Country | US
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Telephone | 904-307-6373
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Fax |
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Provider Business Mailing Address
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Address Line | 1743 COUNTY ROAD 220
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-7917
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Country | US
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Telephone | 904-307-6373
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MELISSA J WHITLOW
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Credential |
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Telephone | 904-307-6373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH9556
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License Number State | FL
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