Individual
MELISSA M SISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6858 SWINNEA RD BLDG 4, SOUTHAVEN, MS 38671-9493
(662) 772-5937
(662) 772-5940
Mailing address
6858 SWINNEA RD BLDG 4, SOUTHAVEN, MS 38671-9493
(662) 772-5937
(662) 772-5940
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC0000000571
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
252567000
MAGELLAN
TN
01
—
4121026
BCBS OF TN PROVIDER #
TN
Enumeration date
05/20/2006
Last updated
07/24/2019
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