Provider Demographics
NPI:1508216664
Name:HIGGINBOTHAM, MELISSA (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S ROSE ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2451
Mailing Address - Country:US
Mailing Address - Phone:870-917-2171
Mailing Address - Fax:870-917-2161
Practice Address - Street 1:201 S ROSE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2451
Practice Address - Country:US
Practice Address - Phone:870-917-2171
Practice Address - Fax:870-917-2161
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1506064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional