Provider Demographics
NPI:1245582055
Name:CHALMERS, MELISSA JEAN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JEAN
Last Name:CHALMERS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 TECHNOLOGY DR NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5118
Mailing Address - Country:US
Mailing Address - Phone:218-751-0282
Mailing Address - Fax:218-751-0870
Practice Address - Street 1:4225 TECHNOLOGY DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5118
Practice Address - Country:US
Practice Address - Phone:218-214-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical