Provider Demographics
NPI:1740358563
Name:MINOR, MELISSA RENA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENA
Last Name:MINOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-0451
Mailing Address - Country:US
Mailing Address - Phone:501-414-0070
Mailing Address - Fax:501-414-0069
Practice Address - Street 1:7123 I-30
Practice Address - Street 2:SUITE 6
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3121
Practice Address - Country:US
Practice Address - Phone:501-414-0070
Practice Address - Fax:501-414-0069
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2336-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical