Provider Demographics
NPI:1598014813
Name:BLACKMER, MELISSA JANE (LMHC, LMFT,)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:BLACKMER
Suffix:
Gender:F
Credentials:LMHC, LMFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E DUPONT RD # 1109
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2051
Mailing Address - Country:US
Mailing Address - Phone:260-450-0444
Mailing Address - Fax:
Practice Address - Street 1:2250 LAKE AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5352
Practice Address - Country:US
Practice Address - Phone:260-247-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002638A101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health