Provider Demographics
NPI:1326592817
Name:WALKER, MELISSA (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4646 POPLAR AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4433
Mailing Address - Country:US
Mailing Address - Phone:901-930-7397
Mailing Address - Fax:
Practice Address - Street 1:4646 POPLAR AVE STE 302
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4433
Practice Address - Country:US
Practice Address - Phone:901-930-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health