Provider Demographics
NPI:1164206868
Name:BENSON, MELISSA GAIL (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16712 STATE HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MO
Mailing Address - Zip Code:63622-9121
Mailing Address - Country:US
Mailing Address - Phone:573-210-3254
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTHTOWNE DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-5729
Practice Address - Country:US
Practice Address - Phone:573-438-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230291801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical