Provider Demographics
NPI:1487660452
Name:TOWER, MELISSA RAE (MA, LLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAE
Last Name:TOWER
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RAE
Other - Last Name:RANNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:3245 RIVERWOODS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9267
Mailing Address - Country:US
Mailing Address - Phone:616-443-5343
Mailing Address - Fax:616-226-4566
Practice Address - Street 1:3245 RIVERWOODS DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9267
Practice Address - Country:US
Practice Address - Phone:616-443-5343
Practice Address - Fax:616-226-4566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010663103T00000X
MI6361006816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108952750OtherBC/BS