Provider Demographics
NPI:1447881271
Name:LOZANO, MELISSA ABIGAIL
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ABIGAIL
Last Name:LOZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 KAVANAUGH RD
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-9541
Mailing Address - Country:US
Mailing Address - Phone:424-645-2058
Mailing Address - Fax:
Practice Address - Street 1:206 E REYNOLDS DR STE F2
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2873
Practice Address - Country:US
Practice Address - Phone:318-224-7223
Practice Address - Fax:318-415-1004
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMFT1576106H00000X, 106H00000X
CAAMFT117572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist