Provider Demographics
NPI:1649328311
Name:TODD, MELISSA TYLER (LPC, CAC II, NCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:TYLER
Last Name:TODD
Suffix:
Gender:F
Credentials:LPC, CAC II, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 AZALEA CT STE C
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5723
Mailing Address - Country:US
Mailing Address - Phone:843-692-7177
Mailing Address - Fax:
Practice Address - Street 1:1304 AZALEA CT STE C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5723
Practice Address - Country:US
Practice Address - Phone:843-692-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health