Provider Demographics
NPI:1154647360
Name:PETRONE, MELISSA R (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:PETRONE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7752 CANDLELIGHT LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4271
Mailing Address - Country:US
Mailing Address - Phone:719-271-9022
Mailing Address - Fax:
Practice Address - Street 1:5195 FONTAINE BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1074
Practice Address - Country:US
Practice Address - Phone:719-271-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5355101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor