Provider Demographics
NPI:1356785950
Name:PIPPIN, MELISSA LEA (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEA
Last Name:PIPPIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 FOWLER FORD RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1900
Mailing Address - Country:US
Mailing Address - Phone:615-566-6837
Mailing Address - Fax:615-822-3111
Practice Address - Street 1:415 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2417
Practice Address - Country:US
Practice Address - Phone:615-566-6837
Practice Address - Fax:615-822-3111
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000055421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical