Provider Demographics
NPI:1669193405
Name:WOOD, MELISSA DIANE (LPC, RPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-1723
Mailing Address - Country:US
Mailing Address - Phone:918-549-1651
Mailing Address - Fax:
Practice Address - Street 1:2106 S 54TH ST STE 3
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8198
Practice Address - Country:US
Practice Address - Phone:479-481-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2411004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP2411004OtherCOMMERCIAL INSURANCE