Provider Demographics
NPI:1659732162
Name:MELTON, KIMBERLY VAUGHN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:VAUGHN
Last Name:MELTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2433
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6200
Mailing Address - Country:US
Mailing Address - Phone:662-638-9331
Mailing Address - Fax:
Practice Address - Street 1:2887 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5349
Practice Address - Country:US
Practice Address - Phone:662-638-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC6172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health