Provider Demographics
NPI:1871564542
Name:SMITH, MELANIE MARIA (MASTERS OF ED, LPC)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MASTERS OF ED, LPC
Other - Prefix:
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Mailing Address - Street 1:206B MAIN ST
Mailing Address - Street 2:COUNSELING CONNECTIONS
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028
Mailing Address - Country:US
Mailing Address - Phone:636-931-0300
Mailing Address - Fax:636-933-3510
Practice Address - Street 1:206B MAIN ST
Practice Address - Street 2:COUNSELING CONNECTIONS
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-931-0300
Practice Address - Fax:636-933-3510
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001031173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498315803Medicaid