Provider Demographics
NPI:1043766884
Name:MELANCON, HAROLD (LPC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:MELANCON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WOODGATE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2285
Mailing Address - Country:US
Mailing Address - Phone:601-831-4133
Mailing Address - Fax:601-636-5739
Practice Address - Street 1:1414 CHERRY ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3218
Practice Address - Country:US
Practice Address - Phone:601-636-5703
Practice Address - Fax:601-636-5739
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional