Provider Demographics
NPI:1639303928
Name:MCCAULEY, MELISSA DAWN (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MO
Mailing Address - Zip Code:63537-1467
Mailing Address - Country:US
Mailing Address - Phone:660-342-4904
Mailing Address - Fax:
Practice Address - Street 1:107 N 6TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537-1467
Practice Address - Country:US
Practice Address - Phone:660-342-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009010209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639303928Medicaid