MEDICARE: MELISSA GROOMS LPCC

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	C.2304882	OH
2	101YP2500X	Professional Counselor	E.2505754	OH

General Provider Information

NPI Number	:	1760152409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GROOMS LPCC

Provider Business Mailing Address
First Line	:	623 PARK MEADOW RD STE H
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2876
Country	:	US
Telephone Number	:	614-948-3273
Fax Number	:	855-740-2025

Provider Business Practice Location Address
First Line	:	623 PARK MEADOW RD STE H
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2876
Country	:	US
Telephone Number	:	614-948-3273
Fax Number	:	855-740-2025

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	04/07/2026

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