Provider Demographics
NPI:1821543786
Name:MCINTOSH, MELISSA LYNNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNNE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNNE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2037 COPPER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:KY
Mailing Address - Zip Code:40419-8860
Mailing Address - Country:US
Mailing Address - Phone:606-392-3958
Mailing Address - Fax:
Practice Address - Street 1:2037 COPPER CREEK RD
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:KY
Practice Address - Zip Code:40419-8860
Practice Address - Country:US
Practice Address - Phone:606-392-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical