Provider Demographics
NPI:1568016798
Name:SMITH, MELISSA DEAN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8106 RED STONE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4614
Mailing Address - Country:US
Mailing Address - Phone:502-438-6460
Mailing Address - Fax:833-953-0891
Practice Address - Street 1:8106 RED STONE HILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4614
Practice Address - Country:US
Practice Address - Phone:502-438-6460
Practice Address - Fax:833-953-0891
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252098106H00000X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100638550Medicaid