Provider Demographics
NPI:1073850970
Name:BEACH, MELISSA K (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:BEACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:KUYKENDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-0305
Mailing Address - Country:US
Mailing Address - Phone:662-651-4637
Mailing Address - Fax:662-651-4636
Practice Address - Street 1:60021 MONROE ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MS
Practice Address - Zip Code:38870-7779
Practice Address - Country:US
Practice Address - Phone:662-651-4637
Practice Address - Fax:662-651-4636
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC82881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical