Provider Demographics
NPI:1558962746
Name:SHOWALTER, MELISSA NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:NICOLE
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 BROOKINGS DR
Mailing Address - Street 2:MSC-1201-323-100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4862
Mailing Address - Country:US
Mailing Address - Phone:314-935-6666
Mailing Address - Fax:314-696-1214
Practice Address - Street 1:1 BROOKINGS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4862
Practice Address - Country:US
Practice Address - Phone:314-935-6666
Practice Address - Fax:314-696-1214
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200098601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical