Provider Demographics
NPI:1275875676
Name:RIESLING, MELISSA R (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:RIESLING
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20431 BALD MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9310
Mailing Address - Country:US
Mailing Address - Phone:719-359-2525
Mailing Address - Fax:
Practice Address - Street 1:1864 WOODMOOR DR
Practice Address - Street 2:SUITE 216
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9095
Practice Address - Country:US
Practice Address - Phone:719-359-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4889OtherPROFESSIONAL COUNSELOR LICENSE