Provider Demographics
NPI:1326154402
Name:MOFFITT, MELISSA JOAN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOAN
Last Name:MOFFITT
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 1:19731 E PIKES PEAK CT STE 206
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7401
Mailing Address - Country:US
Mailing Address - Phone:303-805-4004
Mailing Address - Fax:
Practice Address - Street 1:19731 E PIKES PEAK CT STE 206
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7401
Practice Address - Country:US
Practice Address - Phone:303-805-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2489OtherCOLORADO LIC. NUMBER