Provider Demographics
NPI:1134636830
Name:FOX, MELISSA L (BA, CAC III)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:BA, CAC III
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:IPPOLITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:665 HIGH SIERRA LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-2000
Mailing Address - Country:US
Mailing Address - Phone:970-216-3700
Mailing Address - Fax:
Practice Address - Street 1:660 WHITE AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2744
Practice Address - Country:US
Practice Address - Phone:970-462-1344
Practice Address - Fax:970-243-4235
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0005430101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)