MEDICARE: MELANIE RAMBO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC9847	LA
2	101Y00000X	Counselor	LPC9847	LA
3	101YP2500X	Professional Counselor	LPC9847	LA
4	101Y00000X	Counselor	PLC9847	LA
5	104100000X	Social Worker		LA

General Provider Information

NPI Number	:	1093175168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE RAMBO LPC

Provider Business Mailing Address
First Line	:	1000 CHINABERRY DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2442
Country	:	US
Telephone Number	:	318-216-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	3341 YOUREE DR STE 10B
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2149
Country	:	US
Telephone Number	:	318-675-0804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/06/2026

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