Provider Demographics
NPI:1831938117
Name:ANDERSON, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RAVEN LN
Mailing Address - Street 2:
Mailing Address - City:LUCINDA
Mailing Address - State:PA
Mailing Address - Zip Code:16235-1139
Mailing Address - Country:US
Mailing Address - Phone:814-229-0188
Mailing Address - Fax:
Practice Address - Street 1:1300R E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1214
Practice Address - Country:US
Practice Address - Phone:814-229-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000046101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional