Provider Demographics
NPI:1457609232
Name:GARNER, MELISSA DIANE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DIANE
Last Name:GARNER
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 1:1105 CARLA DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-3837
Mailing Address - Country:US
Mailing Address - Phone:850-449-3883
Mailing Address - Fax:850-610-0483
Practice Address - Street 1:1105 CARLA DR
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-3837
Practice Address - Country:US
Practice Address - Phone:850-449-3883
Practice Address - Fax:850-610-0483
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015030400Medicaid