Provider Demographics
NPI:1760106900
Name:MELTON, COURTNEY J (CAPSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:J
Last Name:MELTON
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 PLEASANT DR APT 2
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-9109
Mailing Address - Country:US
Mailing Address - Phone:715-520-7631
Mailing Address - Fax:
Practice Address - Street 1:1547 STRONGS AVE STE D
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3566
Practice Address - Country:US
Practice Address - Phone:715-303-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132937-121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty