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General NPI Number Information
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NPI Number | 1407234834
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Entity Type | Individual
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Provider Name | MELISSA NELSON MA, LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 217 MIRACLE STRIP PKWY SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548
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Country | US
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Telephone | 833-611-3733
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Fax | 888-959-6012
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Provider Business Mailing Address
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Address Line | P.O. BOX 1004
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City | MARY ESTHER
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State | FL
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Zip | 32569
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Country | US
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Telephone | 833-611-3733
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Fax | 888-959-6013
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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 | MH13396
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License Number State | FL
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