Provider Demographics
NPI:1902955081
Name:EAST, MELINDA DAWN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:DAWN
Last Name:EAST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SOENKER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ST. PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:314-440-1283
Mailing Address - Fax:
Practice Address - Street 1:7332 MEXICO RD
Practice Address - Street 2:
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:314-440-1283
Practice Address - Fax:314-442-4147
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001616731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9415365OtherPRIVATE HEALTHCARE SYSTEM
MO495263121Medicaid