Provider Demographics
NPI:1497223085
Name:HARRISON, MELISSA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:HARRISON
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 1:110 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3362
Mailing Address - Country:US
Mailing Address - Phone:479-967-5570
Mailing Address - Fax:479-890-5364
Practice Address - Street 1:8 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4510
Practice Address - Country:US
Practice Address - Phone:501-354-1561
Practice Address - Fax:501-354-1564
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AR9177C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker