Provider Demographics
NPI:1790358547
Name:TIPTON, MELANIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:TIPTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:M
Other - Last Name:BURRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:636-946-1008
Practice Address - Street 1:1628 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2565
Practice Address - Country:US
Practice Address - Phone:660-359-4600
Practice Address - Fax:660-359-4286
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230332821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical