Provider Demographics
NPI:1942502414
Name:RICHTER, MELISSA KAYE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KAYE
Last Name:RICHTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W LIBERTY ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1345
Mailing Address - Country:US
Mailing Address - Phone:734-761-1033
Mailing Address - Fax:
Practice Address - Street 1:101 W LIBERTY ST
Practice Address - Street 2:SUITE 360
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1345
Practice Address - Country:US
Practice Address - Phone:734-761-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010827271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12156794OtherCAQH