Provider Demographics
NPI:1649728387
Name:COATES, MELISSA MAE (LPC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MAE
Last Name:COATES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:MAE
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:N11510 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ANIWA
Mailing Address - State:WI
Mailing Address - Zip Code:54408-9785
Mailing Address - Country:US
Mailing Address - Phone:715-348-2443
Mailing Address - Fax:
Practice Address - Street 1:2620 STEWART AVE STE 210
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4162
Practice Address - Country:US
Practice Address - Phone:715-848-4884
Practice Address - Fax:715-348-1253
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8587-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional