Provider Demographics
NPI:1558673038
Name:CLOUGH, MELISSA PHYLLIS
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:PHYLLIS
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 FISK RD
Mailing Address - Street 2:
Mailing Address - City:WARE
Mailing Address - State:MA
Mailing Address - Zip Code:01082-9006
Mailing Address - Country:US
Mailing Address - Phone:978-249-9490
Mailing Address - Fax:
Practice Address - Street 1:491 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-1846
Practice Address - Country:US
Practice Address - Phone:978-249-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor