Melissa Ann Peterson, LISW, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

081440 Issued in IA

Practice address

4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098

Phone

(573) 596-0522

NPI assigned

Jun 21, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1306296272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-0522"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Ave M W, Fort Dodge, IA, USA",
            "address_purpose": "LOCATION",
            "city": "Fort Dodge",
            "state": "IA",
            "postal_code": "505015050",
            "country_code": "US",
            "telephone_number": "515-955-4222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "credential": "LISW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-21",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "081440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tate Pearson, DMD
• Erica Jane Pelinski, P.A. - C
• Kenisha Shawnta Pemberton, M.D.
• Uriah Perez, ARNP
• Aren Wilhelm Peterson, DDS
• Pierre R. Pierce, D.D.S.
• Kristi Leigh Pitchford, LCSW
• Cynthia Thomas Plank, RN
• Rexford Allan Plank Jr., PA-C
• Rexford Allan Plank III, PA-C

• Mental Health Counselor in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.