Provider Demographics
NPI:1114138153
Name:DANIELSON, MELISSA (MFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 S EASTERN AVE
Mailing Address - Street 2:SUITE 258
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-8024
Mailing Address - Country:US
Mailing Address - Phone:702-339-5663
Mailing Address - Fax:702-527-7795
Practice Address - Street 1:9480 S EASTERN AVE
Practice Address - Street 2:SUITE 258
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8024
Practice Address - Country:US
Practice Address - Phone:702-339-5663
Practice Address - Fax:702-527-7795
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01078106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist