Provider Demographics
NPI:1619466729
Name:HERN, MELISSA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:HERN
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 1:32 STONES LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:MO
Mailing Address - Zip Code:65754-9400
Mailing Address - Country:US
Mailing Address - Phone:417-230-5814
Mailing Address - Fax:
Practice Address - Street 1:8956 E STATE HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737-9687
Practice Address - Country:US
Practice Address - Phone:172-305-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017035839101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490087069Medicaid