Basic Information
| Provider Information | |||||||||
| NPI: | 1700297579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAIRHURST | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NCC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 ROOSEVELT DR | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064702035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032577930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 731 MAIN ST STE 122 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064682872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032617090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 003148 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.