Provider Demographics
NPI:1164968772
Name:DOUGLASS, MELISSA D (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 CHATEAU DU MONT DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1053
Mailing Address - Country:US
Mailing Address - Phone:314-616-6211
Mailing Address - Fax:
Practice Address - Street 1:1855 CHATEAU DU MONT DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1053
Practice Address - Country:US
Practice Address - Phone:314-616-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160315281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical