Provider Demographics
NPI:1326306838
Name:RAMOS-GREEN, MELANIE ALEXIS (MA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ALEXIS
Last Name:RAMOS-GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ALEXIS
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:8801 E 63RD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4875
Mailing Address - Country:US
Mailing Address - Phone:816-407-1887
Mailing Address - Fax:
Practice Address - Street 1:8801 E 63RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4875
Practice Address - Country:US
Practice Address - Phone:816-407-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013124101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012013124OtherLICENSE NUMBER