Provider Demographics
NPI:1538922935
Name:WILES, MELISSA D (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:WILES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 WINDING RIDGE CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-2314
Mailing Address - Country:US
Mailing Address - Phone:913-486-4166
Mailing Address - Fax:
Practice Address - Street 1:1820 WINDING RIDGE CIR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-2314
Practice Address - Country:US
Practice Address - Phone:913-486-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health