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General NPI Number Information
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NPI Number | 1255782124
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Entity Type | Individual
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Provider Name | MELISSA LEE-TAMMEUS PHD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 8553 ARGYLE BUSINESS LOOP STE 5B
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6604
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Country | US
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Telephone | 904-257-0478
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Fax |
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Provider Business Mailing Address
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Address Line | 2977 GOLDEN POND BLVD
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City | ORANGE PARK
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State | FL
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Zip | 32073-7628
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Country | US
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Telephone | 904-777-8687
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13207
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License Number State | FL
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