Provider Demographics
NPI:1518401389
Name:ROHRBACH, MELISSA (LPC, CRADC, NCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ROHRBACH
Suffix:
Gender:F
Credentials:LPC, CRADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 S FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2159
Mailing Address - Country:US
Mailing Address - Phone:417-619-1595
Mailing Address - Fax:417-777-0180
Practice Address - Street 1:471 S FLINT AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2159
Practice Address - Country:US
Practice Address - Phone:417-619-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO9683101YA0400X
MO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490040398Medicaid