| Doctor Name: | DR. MELISSA JEAN IVEY |
| NPI Number: | 1255547139 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | CC2033 |
| Business Practice Address: | 40 Market Square Houlton, ME - 047301742 |
| Business Phone Number: | 2079418727 |
| Business Fax Number: | 2079922784 |
| Mailing Address: | 21 Main St., Suite 301 BANGOR |
| State: | ME |
| Postal Code: | 044016359 |
| Phone Number: | 2079418727 |
| Fax Number: | 2079922784 |
| NPI Enumeration Date: | 05/15/2007 |
| NPI Last Update Date: | 11/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | CC2033 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |