Provider Demographics
NPI:1063063956
Name:HALE, MELISSA LEE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEE
Last Name:HALE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:MO
Mailing Address - Zip Code:63779-0100
Mailing Address - Country:US
Mailing Address - Phone:573-837-7144
Mailing Address - Fax:636-333-4510
Practice Address - Street 1:10672 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7171
Practice Address - Country:US
Practice Address - Phone:573-837-7144
Practice Address - Fax:636-333-4510
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170387491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE CURRENTLY