Provider Demographics
NPI:1346671690
Name:MELISSA M WILLIAMS LICENSED THERAPIST
Entity Type:Organization
Organization Name:MELISSA M WILLIAMS LICENSED THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-639-1094
Mailing Address - Street 1:1310 OLD HIGHWAY 63 S
Mailing Address - Street 2:SUITE1
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6078
Mailing Address - Country:US
Mailing Address - Phone:573-639-1094
Mailing Address - Fax:
Practice Address - Street 1:1310 OLD HIGHWAY 63 S
Practice Address - Street 2:SUITE1
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6078
Practice Address - Country:US
Practice Address - Phone:573-639-1094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012011623101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881951069Medicaid