Provider Demographics
NPI:1760521173
Name:GILBERT, MELANY R (LPC, RN)
Entity Type:Individual
Prefix:
First Name:MELANY
Middle Name:R
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30469 HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-8128
Mailing Address - Country:US
Mailing Address - Phone:573-774-0053
Mailing Address - Fax:573-774-3053
Practice Address - Street 1:1121 HISTORIC ROUTE 66 WEST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-774-0053
Practice Address - Fax:573-774-3053
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003007325101YP2500X
MO145223163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163W00000XNursing Service ProvidersRegistered Nurse