Provider Demographics
NPI:1023652500
Name:BAGWELL, MELISSA LEE (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LEE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:546 PEACOCK ST
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-7750
Mailing Address - Country:US
Mailing Address - Phone:417-224-0389
Mailing Address - Fax:
Practice Address - Street 1:546 PEACOCK ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-7750
Practice Address - Country:US
Practice Address - Phone:417-224-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health