Provider Demographics
NPI:1306059829
Name:PAGE-WOOD, MELANIE BETH (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:BETH
Last Name:PAGE-WOOD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-9430
Mailing Address - Country:US
Mailing Address - Phone:269-944-1854
Mailing Address - Fax:
Practice Address - Street 1:777 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-5065
Practice Address - Country:US
Practice Address - Phone:269-926-0121
Practice Address - Fax:269-926-0584
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007534101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor