Provider Demographics
NPI:1467842294
Name:BUCHHOLZ, MELISSA A (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-4461
Mailing Address - Country:US
Mailing Address - Phone:701-206-0955
Mailing Address - Fax:
Practice Address - Street 1:402 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-4506
Practice Address - Country:US
Practice Address - Phone:701-206-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4901104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker