Provider Demographics
NPI:1386086445
Name:CLEVENGER, MELISSA PAULINE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:PAULINE
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:PAULINE
Other - Last Name:CLEVENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2460 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1874
Mailing Address - Country:US
Mailing Address - Phone:269-982-3832
Mailing Address - Fax:
Practice Address - Street 1:2460 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1874
Practice Address - Country:US
Practice Address - Phone:269-982-3832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional