Provider Demographics
NPI:1902185838
Name:STAHL, MELISSA LEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEE
Last Name:STAHL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 E HWY 50 STE 302J
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5056
Mailing Address - Country:US
Mailing Address - Phone:636-293-2361
Mailing Address - Fax:
Practice Address - Street 1:1655 E HWY 50 STE 302J
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5056
Practice Address - Country:US
Practice Address - Phone:636-293-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009606101YP2500X
FLMH17453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional