Individual
MELISSA FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
3701 LANSDOWNE DR, ASHLAND, KY 41102
(606) 324-3005
(606) 329-1530
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
103173
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000532644
ANTHEM BCBS (NON PAR)
—
01
—
12656765
CAQH
—
05
—
7100280950
—
KY
Enumeration date
05/07/2007
Last updated
02/25/2019
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