Provider Demographics
NPI:1972260529
Name:LEE, MELISSA JOY (LMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:LEE
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 1:417 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2901
Mailing Address - Country:US
Mailing Address - Phone:605-202-9186
Mailing Address - Fax:
Practice Address - Street 1:2212 PIERCE ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3871
Practice Address - Country:US
Practice Address - Phone:712-255-8323
Practice Address - Fax:712-255-8287
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0957681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical