MEDICARE: MELISSA WILSON 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	11433	MA

General Provider Information

NPI Number	:	1922316470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WILSON LMHC

Provider Business Mailing Address
First Line	:	156 WALPOLE ST
Second Line	:
City	:	CANTON
State	:	MA
Zip	:	02021-1848
Country	:	US
Telephone Number	:	339-987-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	779 WASHINGTON ST STE 3C
Second Line	:
City	:	CANTON
State	:	MA
Zip	:	02021-3022
Country	:	US
Telephone Number	:	339-987-0333
Fax Number	:

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

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	11/03/2025

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