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NPI Code Detail

MEDICARE: MELISSA L WILSON LPC/MHSP

MEDICARE: MELISSA L WILSON LPC/MHSP
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
1101YM0800XMental Health Counselor1623TN

General Provider Information

NPI Number : 1336198647
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA L WILSON LPC/MHSP
Provider Business Mailing Address
First Line : 1923 SULPHUR SPRINGS RD
Second Line :
City : MORRISTOWN
State : TN
Zip : 37813-5654
Country : US
Telephone Number : 423-317-9344
Fax Number : 423-714-2355
Provider Business Practice Location Address
First Line : 5600 BRAINERD RD STE A4
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37411-5336
Country : US
Telephone Number : 423-266-4588
Fax Number : 865-342-0103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2006
Last Update Date : 11/10/2020

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