Provider Demographics
NPI:1912339805
Name:RANKIN-SHORT, MELISSA (MA, LPC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:RANKIN-SHORT
Suffix:
Gender:F
Credentials:MA, LPC, CRC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2705 MULLANPHY LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-3727
Mailing Address - Country:US
Mailing Address - Phone:314-584-6128
Mailing Address - Fax:
Practice Address - Street 1:2705 MULLANPHY LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-3727
Practice Address - Country:US
Practice Address - Phone:314-584-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional