Individual provider Active NPI

Melissa Jo McCready, LPE-I

  • Clinical Psychologist
  • Malvern, AR
National Provider Identifier
1407029606
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
06-11EI Issued in AR
Practice address
829 Halbert St
Malvern, AR 72104-2607
Phone
(501) 332-4400
Fax
(870) 246-4184
NPI assigned
Apr 8, 2008
Last updated
Jul 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 06-11EI AR Primary

Addresses

Primary practice location

829 Halbert St
Malvern, AR 72104-2607

Mailing address

829 Halbert St
Malvern, AR 72104-2607
Phone (501) 332-4400

Other identifiers 1

IdentifierTypeStateIssuer
227955719MedicaidAR

Other names 1

  • Melissa Jo Long Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
06-11EIARMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Auremelle Counseling Past Accepting new patients
Ouachita Regional Counseling & Mental Health Center, Inc. PastSince Jul 1, 2020 Accepting new patients
Ouachita Regional Counseling and Mental Health Center, Inc. PastSince Jul 1, 2020 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1407029606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 HALBERT ST",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721042607",
            "telephone_number": "501-332-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 HALBERT ST",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721042607",
            "telephone_number": "501-332-4400",
            "fax_number": "870-246-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCREADY",
        "first_name": "MELISSA",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "LPE-I",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-08",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "06-11EI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "227955719",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "LONG",
            "middle_name": "JO",
            "credential": "LPE-I",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Malvern, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.