Provider Demographics
NPI:1114270410
Name:PAULSEN OBERBRECKLING, MELISSA ANN (MA, LMFT, RPT-S)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:PAULSEN OBERBRECKLING
Suffix:
Gender:F
Credentials:MA, LMFT, RPT-S
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PAULSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT, RPT-S
Mailing Address - Street 1:213 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-5701
Mailing Address - Country:US
Mailing Address - Phone:319-224-0722
Mailing Address - Fax:877-728-2951
Practice Address - Street 1:213 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-5701
Practice Address - Country:US
Practice Address - Phone:319-224-0722
Practice Address - Fax:877-728-2951
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist