Provider Demographics
NPI:1386067205
Name:HARRIS, MELISSA FULBRIGHT I (SWT, QMHP, QMRP,CMHP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:FULBRIGHT
Last Name:HARRIS
Suffix:I
Gender:F
Credentials:SWT, QMHP, QMRP,CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S CRAPO ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2941
Mailing Address - Country:US
Mailing Address - Phone:989-772-5938
Mailing Address - Fax:989-775-7701
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5938
Practice Address - Fax:989-775-7701
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2229235104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker