Provider Demographics
NPI:1790816338
Name:COLEMAN, MELISSA S (LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:S
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 BROOKWOOD LAKE PL
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-5648
Mailing Address - Country:US
Mailing Address - Phone:601-382-4523
Mailing Address - Fax:601-510-5860
Practice Address - Street 1:135 BOUNDS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4121
Practice Address - Country:US
Practice Address - Phone:601-382-4523
Practice Address - Fax:601-510-5860
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional