Provider Demographics
NPI:1457642720
Name:CAMPOS, MELISSA ANNETTE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNETTE
Last Name:CAMPOS
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 1:4425 MILITARY TRL
Mailing Address - Street 2:#203
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4819
Mailing Address - Country:US
Mailing Address - Phone:561-747-2775
Mailing Address - Fax:561-747-1881
Practice Address - Street 1:4425 MILITARY TRL
Practice Address - Street 2:#203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4819
Practice Address - Country:US
Practice Address - Phone:561-747-2775
Practice Address - Fax:561-747-1881
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FLMH9360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002147800Medicaid