Provider Demographics
NPI:1073391793
Name:IBARRA, MELISSA JOANNA (LHMC)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:JOANNA
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 SUNSET DR STE 225
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5700
Mailing Address - Country:US
Mailing Address - Phone:305-707-1604
Mailing Address - Fax:786-772-7581
Practice Address - Street 1:1533 SUNSET DR STE 225
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-5700
Practice Address - Country:US
Practice Address - Phone:305-707-1604
Practice Address - Fax:786-772-7581
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health