Provider Demographics
NPI:1710662739
Name:JIBSON, MELISSA ANN (LLPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:JIBSON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6139 DUTCHMAN BAY RD
Mailing Address - Street 2:
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-8666
Mailing Address - Country:US
Mailing Address - Phone:231-292-6141
Mailing Address - Fax:
Practice Address - Street 1:3290 WOODS WAY
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8694
Practice Address - Country:US
Practice Address - Phone:231-292-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional