Provider Demographics
NPI:1871967687
Name:LEIGHTY, MELISSA KAYE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAYE
Last Name:LEIGHTY
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 1:215 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-1118
Mailing Address - Country:US
Mailing Address - Phone:417-469-3260
Mailing Address - Fax:417-469-5127
Practice Address - Street 1:215 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-1118
Practice Address - Country:US
Practice Address - Phone:417-469-3260
Practice Address - Fax:417-469-5127
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8868101YA0400X
MO2019009295101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health