Provider Demographics
NPI:1194024752
Name:WADSWORTH, MELISSA DALE (LMFTI)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DALE
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:LMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 DOVER BAY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2131
Mailing Address - Country:US
Mailing Address - Phone:702-485-9917
Mailing Address - Fax:702-982-6888
Practice Address - Street 1:3529 DOVER BAY ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-2131
Practice Address - Country:US
Practice Address - Phone:702-485-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVM10548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194024752Medicaid