Provider Demographics
NPI:1104196229
Name:DOUCETTE, MELISSA BETH (MA LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 FARMERS LN
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-2278
Mailing Address - Country:US
Mailing Address - Phone:612-242-3171
Mailing Address - Fax:
Practice Address - Street 1:12751 COUNTY ROAD 5
Practice Address - Street 2:SUITE 101
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2263
Practice Address - Country:US
Practice Address - Phone:612-242-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist