Provider Demographics
NPI:1053644047
Name:NOEL, MELISSA JON (PSYD, CACII)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JON
Last Name:NOEL
Suffix:
Gender:F
Credentials:PSYD, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1817
Mailing Address - Country:US
Mailing Address - Phone:303-345-7611
Mailing Address - Fax:
Practice Address - Street 1:4900 E CHERRY CREEK SOUTH DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2283
Practice Address - Country:US
Practice Address - Phone:303-345-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COPSYC.00014089103TC0700X
COACB.0007055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty