Provider Demographics
NPI:1679612899
Name:MILLER, MELODIE COLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:COLE
Last Name:MILLER
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 1:10476 RED STONE DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1972
Mailing Address - Country:US
Mailing Address - Phone:901-853-2819
Mailing Address - Fax:
Practice Address - Street 1:111 RACINE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2707
Practice Address - Country:US
Practice Address - Phone:901-323-3600
Practice Address - Fax:901-323-3640
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional