Provider Demographics
NPI:1184087280
Name:PHILLIPS, MELISSA R (LISW, LCDC-III)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LISW, LCDC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 CLARK DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3726
Mailing Address - Country:US
Mailing Address - Phone:614-579-0134
Mailing Address - Fax:
Practice Address - Street 1:6100 CHANNINGWAY BLVD STE 606
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2999
Practice Address - Country:US
Practice Address - Phone:740-785-6188
Practice Address - Fax:614-754-5026
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2304606104100000X, 1041C0700X
OHS.1701768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical