Provider Demographics
NPI:1235813833
Name:TUBBS, MELANIE ROGERS (LMSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROGERS
Last Name:TUBBS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-9172
Mailing Address - Country:US
Mailing Address - Phone:662-312-6698
Mailing Address - Fax:
Practice Address - Street 1:139 N BROOKMOORE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2024
Practice Address - Country:US
Practice Address - Phone:662-328-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM8218104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty