Provider Demographics
NPI:1598854887
Name:REID, MELISSA MICHELLE (LMSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MICHELLE
Last Name:REID
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 W MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-9638
Mailing Address - Country:US
Mailing Address - Phone:231-343-0095
Mailing Address - Fax:
Practice Address - Street 1:116 W COLBY ST
Practice Address - Street 2:STE E
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1084
Practice Address - Country:US
Practice Address - Phone:231-343-0095
Practice Address - Fax:231-725-7241
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010813421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30280Medicare ID - Type Unspecified