Provider Demographics
NPI:1952658809
Name:MISTROT, MELISSA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MISTROT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2411
Mailing Address - Country:US
Mailing Address - Phone:337-654-1734
Mailing Address - Fax:
Practice Address - Street 1:1011 HARDING ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2411
Practice Address - Country:US
Practice Address - Phone:337-654-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor