Provider Demographics
NPI:1659335180
Name:PUPLE, MELANIE DAWN (MSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:PUPLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:DAWN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:812 E JOLLY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6818
Mailing Address - Country:US
Mailing Address - Phone:517-346-8410
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:812 E JOLLY RD
Practice Address - Street 2:SUITE G14
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6818
Practice Address - Country:US
Practice Address - Phone:517-346-8276
Practice Address - Fax:517-346-8290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010619861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical