Provider Demographics
NPI:1043761588
Name:NILLES, MELISSA LEE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LEE
Last Name:NILLES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HIGHLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1431
Mailing Address - Country:US
Mailing Address - Phone:617-733-4013
Mailing Address - Fax:
Practice Address - Street 1:220 HIGHLAND AVE APT 3
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1431
Practice Address - Country:US
Practice Address - Phone:617-733-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health