Provider Demographics
NPI:1407234834
Name:NELSON, MELISSA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1004
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569
Mailing Address - Country:US
Mailing Address - Phone:833-611-3733
Mailing Address - Fax:888-959-6013
Practice Address - Street 1:217 MIRACLE STRIP PKWY SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:833-611-3733
Practice Address - Fax:888-959-6012
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health