Provider Demographics
NPI:1154450955
Name:ROBERTS-FUSTON, MELANIE BEVERELY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:BEVERELY
Last Name:ROBERTS-FUSTON
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 1:6290 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49111-9654
Mailing Address - Country:US
Mailing Address - Phone:575-361-4844
Mailing Address - Fax:
Practice Address - Street 1:331 SIJAN AVE
Practice Address - Street 2:
Practice Address - City:WHITEMAN AIR FORCE BASE
Practice Address - State:MO
Practice Address - Zip Code:65305-1269
Practice Address - Country:US
Practice Address - Phone:660-687-4341
Practice Address - Fax:660-687-5256
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010986561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical