Provider Demographics
NPI:1700201720
Name:ANGUISH, MELISSA (PC, CR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ANGUISH
Suffix:
Gender:F
Credentials:PC, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E PARK AVE
Mailing Address - Street 2:P.O 683
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2352
Mailing Address - Country:US
Mailing Address - Phone:330-544-8005
Mailing Address - Fax:
Practice Address - Street 1:165 E PARK AVE
Practice Address - Street 2:P.O 683
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2352
Practice Address - Country:US
Practice Address - Phone:330-544-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health