Provider Demographics
NPI:1023490455
Name:MELKUMYAN, ANNA (LMSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MELKUMYAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:SCATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1550 WATERTOWER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3496 E LAKE LANSING RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6222
Practice Address - Country:US
Practice Address - Phone:517-862-1615
Practice Address - Fax:517-913-6154
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker