Provider Demographics
NPI:1356460349
Name:KAPPES, MELISSA DAWN (PCC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DAWN
Last Name:KAPPES
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8479 S. MASON MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-4023
Mailing Address - Country:US
Mailing Address - Phone:513-443-2032
Mailing Address - Fax:513-725-1141
Practice Address - Street 1:8479 S. MASON MONTGOMERY ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-4023
Practice Address - Country:US
Practice Address - Phone:513-443-2032
Practice Address - Fax:513-725-1141
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600449101YP2500X
OHE.0600449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2427056Medicaid