1710170667 NPI number — MELISSA N MCDOWELL LPC

Table of content: MELISSA N MCDOWELL LPC (NPI 1710170667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710170667 NPI number — MELISSA N MCDOWELL LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDOWELL
Provider First Name:
MELISSA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710170667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 SHILOH FIRETOWER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOXWORTH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39483-4871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-814-0353
Provider Business Mailing Address Fax Number:
601-510-9163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 HARDY ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39401-4978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-814-0353
Provider Business Practice Location Address Fax Number:
601-510-9163
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  844 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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