=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225507924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA A. LOY M.ED., LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2018
-----------------------------------------------------
Last Update Date | 11/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 S ARCH ST STE 5
-----------------------------------------------------
City | CONNELLSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15425-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-322-5178
-----------------------------------------------------
Fax | 724-603-2503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 S ARCH ST STE 5
-----------------------------------------------------
City | CONNELLSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15425-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-322-5178
-----------------------------------------------------
Fax | 724-603-2503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC010843
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------