Provider Demographics
NPI:1508354465
Name:MELISSA R TOWER
Entity Type:Organization
Organization Name:MELISSA R TOWER
Other - Org Name:MELISSA R TOWER MA LLP
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:616-443-5343
Mailing Address - Street 1:4829 E BELTLINE AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9349
Mailing Address - Country:US
Mailing Address - Phone:866-752-2359
Mailing Address - Fax:
Practice Address - Street 1:4829 E BELTLINE AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9349
Practice Address - Country:US
Practice Address - Phone:866-752-2359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010663103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty