Provider Demographics
NPI:1962071761
Name:VERNON, MELISSA (MS, CMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VERNON
Suffix:
Gender:F
Credentials:MS, CMHC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MICHELLE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CMHC
Mailing Address - Street 1:168 N 1950 W STE 201
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-3007
Mailing Address - Country:US
Mailing Address - Phone:801-213-2537
Mailing Address - Fax:
Practice Address - Street 1:168 N 1950 W STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3007
Practice Address - Country:US
Practice Address - Phone:801-213-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9482677-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health