MEDICARE: MRS. MELISSA MARIE VARGAS LMSW, CCS, CAADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	C-03022	MI
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker	6801096528	MI

General Provider Information

NPI Number	:	1184138505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA MARIE VARGAS LMSW, CCS, CAADC

Provider Business Mailing Address
First Line	:	770 RIVERSIDE AVE STE 11
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-1465
Country	:	US
Telephone Number	:	517-264-2244
Fax Number	:	517-263-3325

Provider Business Practice Location Address
First Line	:	770 RIVERSIDE AVE STE 11
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-1465
Country	:	US
Telephone Number	:	517-264-2244
Fax Number	:	517-263-3325

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

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	11/06/2024

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