Provider Demographics
NPI:1669250395
Name:MCGEE, MELISSA DANIELLE (CIT#5458)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DANIELLE
Last Name:MCGEE
Suffix:
Gender:F
Credentials:CIT#5458
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6705
Mailing Address - Country:US
Mailing Address - Phone:337-345-6124
Mailing Address - Fax:337-524-1420
Practice Address - Street 1:401 W VERMILION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6729
Practice Address - Country:US
Practice Address - Phone:337-345-6129
Practice Address - Fax:337-524-1420
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5458101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)