Provider Demographics
NPI:1992740724
Name:HEATH, MELISSA L (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:HEATH
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HERRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:2778 ELKHORN RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8634
Mailing Address - Country:US
Mailing Address - Phone:270-789-7462
Mailing Address - Fax:877-638-1152
Practice Address - Street 1:2778 ELKHORN RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8634
Practice Address - Country:US
Practice Address - Phone:270-789-7462
Practice Address - Fax:877-638-1152
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31691041C0700X
KY720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical