Provider Demographics
NPI:1922249648
Name:JONES, MELISSA DIANNE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DIANNE
Last Name:JONES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:DIANNE
Other - Last Name:VAN BLARICOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:608 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-2329
Mailing Address - Country:US
Mailing Address - Phone:270-586-4645
Mailing Address - Fax:270-586-4647
Practice Address - Street 1:608 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2329
Practice Address - Country:US
Practice Address - Phone:270-586-4645
Practice Address - Fax:270-586-4647
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1071101Y00000X, 101YA0400X, 101YM0800X, 102L00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100266630Medicaid