Provider Demographics
NPI:1003586611
Name:CAUTHEN, MELISSA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:CAUTHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2434
Mailing Address - Country:US
Mailing Address - Phone:618-559-6346
Mailing Address - Fax:
Practice Address - Street 1:1016 S EMERALD LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2434
Practice Address - Country:US
Practice Address - Phone:618-559-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL149.023198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health