Provider Demographics
NPI:1235811407
Name:COUCH, MELISSA D (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:COUCH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:475 STATION CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-7411
Mailing Address - Country:US
Mailing Address - Phone:601-408-6069
Mailing Address - Fax:
Practice Address - Street 1:475 STATION CREEK RD
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-7411
Practice Address - Country:US
Practice Address - Phone:601-408-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTO324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty