Provider Demographics
NPI:1245556802
Name:DIDISSE, MELODY ANN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:DIDISSE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2338
Mailing Address - Country:US
Mailing Address - Phone:714-824-7969
Mailing Address - Fax:
Practice Address - Street 1:8199 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7163
Practice Address - Country:US
Practice Address - Phone:303-731-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 58406106H00000X
COCO.0001435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist