Provider Demographics
NPI:1982740452
Name:MELTON, BRENDA SUE (LPC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SUE
Last Name:MELTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:POTZ KIEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7711 KENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4307
Mailing Address - Country:US
Mailing Address - Phone:314-808-2382
Mailing Address - Fax:314-395-8433
Practice Address - Street 1:7711 KENRIDGE LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4307
Practice Address - Country:US
Practice Address - Phone:314-808-2382
Practice Address - Fax:341-395-8433
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional