Doctor Name: | MS. LISA RENEE MELTON |
NPI Number: | 1023054988 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | |
Business Practice Address: | 412 S 14th St Herrin, IL - 629483802 |
Business Phone Number: | 6189671790 |
Business Fax Number: | 6183514948 |
Mailing Address: | 412 S 14th St, HERRIN |
State: | IL |
Postal Code: | 629483802 |
Phone Number: | 6189671790 |
Fax Number: | 6183514948 |
NPI Enumeration Date: | 06/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |