Provider Demographics
NPI:1679579353
Name:MELTON, EDDIE C (LPC)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:C
Last Name:MELTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14462
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65814-0462
Mailing Address - Country:US
Mailing Address - Phone:417-581-4849
Mailing Address - Fax:417-581-4839
Practice Address - Street 1:4699 N 21ST ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7684
Practice Address - Country:US
Practice Address - Phone:417-258-1484
Practice Address - Fax:417-581-4839
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional