Provider Demographics
NPI:1720463839
Name:GRANT, MELISSA (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 ROYAL OAK DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1015
Mailing Address - Country:US
Mailing Address - Phone:814-440-7394
Mailing Address - Fax:
Practice Address - Street 1:5180 CAMPBELLS RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9731
Practice Address - Country:US
Practice Address - Phone:412-788-8219
Practice Address - Fax:412-788-8215
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional