Provider Demographics
NPI:1821543786
Name:MCINTOSH, MELISSA LYNNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNNE
Last Name:MCINTOSH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNNE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:319 JOHNNY DR
Mailing Address - Street 2:
Mailing Address - City:SCIENCE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:42553-9146
Mailing Address - Country:US
Mailing Address - Phone:606-392-3958
Mailing Address - Fax:
Practice Address - Street 1:116 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1448
Practice Address - Country:US
Practice Address - Phone:606-392-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100762910Medicaid