Provider Demographics
NPI:1427263979
Name:MARTIN, MELANIE A (LPC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
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 1267
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1267
Mailing Address - Country:US
Mailing Address - Phone:573-332-0416
Mailing Address - Fax:573-335-2698
Practice Address - Street 1:113 NORTH FIRST ST.
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565
Practice Address - Country:US
Practice Address - Phone:573-775-4445
Practice Address - Fax:573-775-4467
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005016774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health