Provider Demographics
NPI:1134759392
Name:TERRELL, MELISSA CONDITT (LMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CONDITT
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W 68TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5338
Mailing Address - Country:US
Mailing Address - Phone:917-734-5078
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE RM 610
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5004
Practice Address - Country:US
Practice Address - Phone:917-734-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional