Provider Demographics
NPI:1326325382
Name:RIDGE, MELISSA M (LLPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:M
Last Name:RIDGE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CONSTITUTION CIR
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-9521
Mailing Address - Country:US
Mailing Address - Phone:517-983-9406
Mailing Address - Fax:
Practice Address - Street 1:219 CONSTITUTION CIR
Practice Address - Street 2:
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-9521
Practice Address - Country:US
Practice Address - Phone:517-983-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional