MEDICARE: MELISSA ANN WHITE LPC, LCPC

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	101YP2500X	Professional Counselor	180.009329	IL
2	101YP2500X	Professional Counselor	2022032993	MO

General Provider Information

NPI Number	:	1285066464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN WHITE LPC, LCPC

Provider Business Mailing Address
First Line	:	1800 COMMUNITY
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-8804
Country	:	US
Telephone Number	:	660-885-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 VANDALIA ST
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-4060
Country	:	US
Telephone Number	:	618-343-6015
Fax Number	:	618-259-2495

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

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	09/16/2022

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