Provider Demographics
NPI:1073004164
Name:WARE-MASSIE, MELODY C (LPC)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:C
Last Name:WARE-MASSIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MELODY
Other - Middle Name:CRISONYA
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 S HARLAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2261
Mailing Address - Country:US
Mailing Address - Phone:720-272-1289
Mailing Address - Fax:
Practice Address - Street 1:265 S HARLAN ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2261
Practice Address - Country:US
Practice Address - Phone:770-256-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85614101YP2500X
CO0018829101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21782369Medicaid