Provider Demographics
NPI:1700337011
Name:GREEN, MELISSA (LPC-S)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2844
Mailing Address - Country:US
Mailing Address - Phone:318-878-6650
Mailing Address - Fax:318-878-6657
Practice Address - Street 1:501 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-3001
Practice Address - Country:US
Practice Address - Phone:318-878-6650
Practice Address - Fax:318-878-6657
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional