Provider Demographics
NPI:1053864975
Name:BAIR, MELISSA KAY (MED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:BAIR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:PERRY-BAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAPC
Mailing Address - Street 1:316 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5218
Mailing Address - Country:US
Mailing Address - Phone:701-774-4660
Mailing Address - Fax:701-774-4620
Practice Address - Street 1:316 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5218
Practice Address - Country:US
Practice Address - Phone:701-774-4660
Practice Address - Fax:701-774-4620
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
ND1183-3-1-22A101YM0800X
ND1183-3-1-22101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator