Provider Demographics
NPI:1811191737
Name:TESTER, MELISSA ANN (LSW, LICDC-CS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:TESTER
Suffix:
Gender:F
Credentials:LSW, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BEACON BEHAVIORAL HEALTH SERVICES
Mailing Address - Street 2:114 N. WOOD ST
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420
Mailing Address - Country:US
Mailing Address - Phone:567-201-2048
Mailing Address - Fax:567-280-4395
Practice Address - Street 1:114 N WOOD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2440
Practice Address - Country:US
Practice Address - Phone:567-201-2048
Practice Address - Fax:567-280-4395
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011125101YA0400X
OHS.1450600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0442902Medicaid
OH0291291Medicaid
OH0440784Medicaid