Provider Demographics
NPI:1972588283
Name:COLTON, MELISSA ANN (NCC, LPC, LMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:COLTON
Suffix:
Gender:F
Credentials:NCC, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 N RONALD REAGAN BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3534
Mailing Address - Country:US
Mailing Address - Phone:407-215-0095
Mailing Address - Fax:
Practice Address - Street 1:2290 N RONALD REAGAN BLVD STE 116
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3534
Practice Address - Country:US
Practice Address - Phone:407-215-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001004968101YP2500X
FLMH7533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116241500Medicaid