Provider Demographics
NPI:1467128942
Name:HOUSEMAN, MELISSA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:HOUSEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 E H AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-6138
Mailing Address - Country:US
Mailing Address - Phone:859-279-9011
Mailing Address - Fax:
Practice Address - Street 1:541 BUTTERMILK PIKE STE 200
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1696
Practice Address - Country:US
Practice Address - Phone:859-869-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2586911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty