Provider Demographics
NPI:1235795188
Name:DEWERFF, MELANIE (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DEWERFF
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 1:1961 CARR AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2868 SUMMER OAKS DR STE 103
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2818
Practice Address - Country:US
Practice Address - Phone:931-216-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4579101YM0800X, 101YP2500X
MA13382101YM0800X, 101YP2500X
CALPCC12065101YP2500X
NVCP5191-R101YP2500X
VA0701012041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health