Provider Demographics
NPI:1659059756
Name:BLOWER, MELISSA J (LPCC 13751)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:BLOWER
Suffix:
Gender:F
Credentials:LPCC 13751
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6878 AVIENDA DE LOS FOOTHILLS
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-4270
Mailing Address - Country:US
Mailing Address - Phone:949-233-2996
Mailing Address - Fax:
Practice Address - Street 1:6878 AVIENDA DE LOS FOOTHILLS
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-4270
Practice Address - Country:US
Practice Address - Phone:949-233-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional