Provider Demographics
NPI:1619210978
Name:MCKOWEN, MELISSA MAE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MAE
Last Name:MCKOWEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 ESSEN LN STE 1
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3563
Mailing Address - Country:US
Mailing Address - Phone:225-388-5497
Mailing Address - Fax:225-636-2017
Practice Address - Street 1:5215 ESSEN LN STE 1
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3563
Practice Address - Country:US
Practice Address - Phone:225-388-5497
Practice Address - Fax:225-636-2017
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional