Provider Demographics
NPI:1558832964
Name:BAKAS, MELISSA SPARKMAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SPARKMAN
Last Name:BAKAS
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 1:1928 CHIMNEY SWIFT HOLW
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3565
Mailing Address - Country:US
Mailing Address - Phone:850-832-7650
Mailing Address - Fax:
Practice Address - Street 1:1928 CHIMNEY SWIFT HOLW
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3565
Practice Address - Country:US
Practice Address - Phone:850-832-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL76101041C0700X
TN69421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical