Provider Demographics
NPI:1356863799
Name:BALENT, MELISSA LYNN (MA, LPC LAC, NCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:BALENT
Suffix:
Gender:F
Credentials:MA, LPC LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 WELTON ST STE 200 # 1033
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4268
Mailing Address - Country:US
Mailing Address - Phone:970-238-2817
Mailing Address - Fax:833-222-3726
Practice Address - Street 1:2590 WELTON ST STE 200 # 1033
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4268
Practice Address - Country:US
Practice Address - Phone:970-238-2817
Practice Address - Fax:833-222-3726
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000699101YA0400X
COLPC.0012987101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05621997Medicaid
CO9000149152Medicaid
CO985098Medicaid