Provider Demographics
NPI:1194182410
Name:MELISSA WHITLOW LMHC
Entity Type:Organization
Organization Name:MELISSA WHITLOW LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-307-6373
Mailing Address - Street 1:1743 COUNTY ROAD 220
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7917
Mailing Address - Country:US
Mailing Address - Phone:904-307-6373
Mailing Address - Fax:
Practice Address - Street 1:329 W ADELAIDE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6931
Practice Address - Country:US
Practice Address - Phone:904-307-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9556251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health