Provider Demographics
NPI:1811347974
Name:MILLER, MELISSA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:492 CHAMPLAIN CT
Mailing Address - Street 2:
Mailing Address - City:BELLE RIVER
Mailing Address - State:ON
Mailing Address - Zip Code:N0R1A0
Mailing Address - Country:CA
Mailing Address - Phone:956-536-6655
Mailing Address - Fax:
Practice Address - Street 1:EMERALD COAST BEHAVIORAL HOSPITAL OUTPATIENT CLINIC
Practice Address - Street 2:1940 HARRISON AVE
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-481-0306
Practice Address - Fax:850-481-0309
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010993191041C0700X
FLSW205121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical