Provider Demographics
NPI:1275951691
Name:MAYER, MELISSA S (LCPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:MAYER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4406
Mailing Address - Country:US
Mailing Address - Phone:406-770-3000
Mailing Address - Fax:406-315-2542
Practice Address - Street 1:916 13TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4406
Practice Address - Country:US
Practice Address - Phone:406-770-3000
Practice Address - Fax:406-315-2542
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-7821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional