Provider Demographics
NPI:1891150041
Name:HART, MELISSA (MA, LPCC, TCADC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MA, LPCC, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3240
Mailing Address - Country:US
Mailing Address - Phone:502-545-4284
Mailing Address - Fax:502-871-5049
Practice Address - Street 1:138 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3240
Practice Address - Country:US
Practice Address - Phone:502-545-4284
Practice Address - Fax:502-871-5049
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165090101YA0400X
KY239932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)