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NPI Code Detail

MEDICARE: MRS. MELISSA CANTERBURY LMFT

MEDICARE: MRS. MELISSA CANTERBURY LMFT
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
1106H00000XMarriage & Family TherapistMFT001002GA
2106H00000XMarriage & Family TherapistLMT0000000714TN

General Provider Information

NPI Number : 1780890897
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA CANTERBURY LMFT
Provider Business Mailing Address
First Line : 111 RACINE ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-2707
Country : US
Telephone Number : 901-323-3600
Fax Number : 901-323-3640
Provider Business Practice Location Address
First Line : 3251 POPLAR AVE
Second Line : SUITE 230
City : MEMPHIS
State : TN
Zip : 38111-3609
Country : US
Telephone Number : 901-323-3600
Fax Number : 901-323-3640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 05/16/2008

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Directions to “ MRS. MELISSA CANTERBURY LMFT” Practice Location

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