Provider Demographics
NPI:1437572591
Name:RUPPERT, MELINDA (LGPC)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41900 FENWICK ST
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3814
Mailing Address - Country:US
Mailing Address - Phone:301-475-8860
Mailing Address - Fax:
Practice Address - Street 1:41900 FENWICK ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3814
Practice Address - Country:US
Practice Address - Phone:301-475-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5504101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561803Medicaid