Provider Demographics
NPI:1578603403
Name:AUSTIN, MELISSA B (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:B
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3838
Mailing Address - Country:US
Mailing Address - Phone:859-314-1281
Mailing Address - Fax:859-353-8032
Practice Address - Street 1:1043 CENTER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3838
Practice Address - Country:US
Practice Address - Phone:859-314-1281
Practice Address - Fax:859-353-8032
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30515058Medicaid
KY30515058Medicaid