| Doctor Name: | MELISSA FANNIN |
| NPI Number: | 1013120054 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | 1366 |
| Business Practice Address: | 3701 Lansdowne Dr Ashland, KY - 41102 |
| Business Phone Number: | 6063243005 |
| Business Fax Number: | 6063291530 |
| Mailing Address: | Po Box 790, ASHLAND |
| State: | KY |
| Postal Code: | 411050790 |
| Phone Number: | 6063298588 |
| Fax Number: | 6063298195 |
| NPI Enumeration Date: | 05/07/2007 |
| NPI Last Update Date: | 11/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1366 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |