Provider Demographics
NPI:1356700710
Name:HANSFORD, MELISSA JANE (LPCC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JANE
Last Name:HANSFORD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:JEFFRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:74 FALIN LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1791
Mailing Address - Country:US
Mailing Address - Phone:606-304-7994
Mailing Address - Fax:
Practice Address - Street 1:109 S 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1221
Practice Address - Country:US
Practice Address - Phone:606-304-7994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN4786101YP2500X
KY242650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY242650OtherSTATE LICENSE
KY7100566260Medicaid
TNLPC4786OtherSTATE LICENSE
TNQ047626Medicaid