MEDICARE: MELISSA BROOKE TANNEN LPC, LMHC

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

General Provider Information

NPI Number	:	1578900650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BROOKE TANNEN LPC, LMHC

Provider Business Mailing Address
First Line	:	22 US OVAL STE 100
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 US OVAL STE 100
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-5901
Country	:	US
Telephone Number	:	518-563-8000
Fax Number	:

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

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	09/29/2025

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