Provider Demographics
NPI:1538632138
Name:MELENDEZ-BONNOT, ELIZABETH BERNADETTE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BERNADETTE
Last Name:MELENDEZ-BONNOT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BERNADETTE
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0777
Mailing Address - Country:US
Mailing Address - Phone:877-406-2662
Mailing Address - Fax:
Practice Address - Street 1:304 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556-7101
Practice Address - Country:US
Practice Address - Phone:877-406-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018014131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional