Provider Demographics
NPI:1750512786
Name:MELARAGNO, SUSAN EMILY (MED, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EMILY
Last Name:MELARAGNO
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 OLIVE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5454
Mailing Address - Country:US
Mailing Address - Phone:636-675-0974
Mailing Address - Fax:314-275-2301
Practice Address - Street 1:12400 OLIVE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5454
Practice Address - Country:US
Practice Address - Phone:636-675-0974
Practice Address - Fax:314-275-2301
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional