Provider Demographics
NPI:1184028151
Name:MELLENDORF, ALYSON MAE FLEMMING (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:MAE FLEMMING
Last Name:MELLENDORF
Suffix:
Gender:F
Credentials:LMFT
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Mailing Address - Street 1:3833 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2643
Mailing Address - Country:US
Mailing Address - Phone:763-767-3350
Mailing Address - Fax:763-767-0912
Practice Address - Street 1:3701 12TH ST N STE 203
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2253
Practice Address - Country:US
Practice Address - Phone:320-253-3512
Practice Address - Fax:320-253-1037
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2017-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist