Provider Demographics
NPI:1235525353
Name:PATTERSON, MELANIE PAGE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:PAGE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 STATE ROUTE 197
Mailing Address - Street 2:
Mailing Address - City:BEECH BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:38313-1739
Mailing Address - Country:US
Mailing Address - Phone:731-267-9715
Mailing Address - Fax:
Practice Address - Street 1:575 S ROYAL ST STE 38
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7307
Practice Address - Country:US
Practice Address - Phone:731-410-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1710361101YM0800X
TN4164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health