Provider Demographics
NPI:1790364784
Name:EMMOREY, MELISSA JOANNE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOANNE
Last Name:EMMOREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20569 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-8059
Mailing Address - Country:US
Mailing Address - Phone:231-580-1437
Mailing Address - Fax:
Practice Address - Street 1:20569 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8059
Practice Address - Country:US
Practice Address - Phone:231-580-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor