Provider Demographics
NPI:1780890897
Name:CANTERBURY, MELISSA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RACINE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2707
Mailing Address - Country:US
Mailing Address - Phone:901-323-3600
Mailing Address - Fax:901-323-3640
Practice Address - Street 1:3251 POPLAR AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3609
Practice Address - Country:US
Practice Address - Phone:901-323-3600
Practice Address - Fax:901-323-3640
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001002106H00000X
TNLMT0000000714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist