Provider Demographics
NPI:1437665072
Name:KINSER, MELISSA SUZANNE (PSY PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUZANNE
Last Name:KINSER
Suffix:
Gender:F
Credentials:PSY PHD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0114
Mailing Address - Country:US
Mailing Address - Phone:423-622-1551
Mailing Address - Fax:877-856-7133
Practice Address - Street 1:3 S HILL ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4289
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:877-856-7133
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3074103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool