Provider Demographics
NPI:1255688206
Name:MCPHERSON, MELISSA CLARECE (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CLARECE
Last Name:MCPHERSON
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 1:2445 N LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-4842
Mailing Address - Country:US
Mailing Address - Phone:316-688-5207
Mailing Address - Fax:
Practice Address - Street 1:2445 N LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-4842
Practice Address - Country:US
Practice Address - Phone:316-688-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker