Provider Demographics
NPI:1588444590
Name:HECKATHORN, MELISA S (LMSW)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:S
Last Name:HECKATHORN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 TOLAS PL SPC 18
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-8998
Mailing Address - Country:US
Mailing Address - Phone:775-217-0228
Mailing Address - Fax:775-507-7224
Practice Address - Street 1:4600 KIETZKE LN STE N250
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5000
Practice Address - Country:US
Practice Address - Phone:775-500-0396
Practice Address - Fax:775-507-7224
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11029-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical