Provider Demographics
NPI:1467907485
Name:MELBOURNE COUNSELING LLC.
Entity Type:Organization
Organization Name:MELBOURNE COUNSELING LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:720-251-5628
Mailing Address - Street 1:7853 E. ARAPAHOE CT,
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1377
Mailing Address - Country:US
Mailing Address - Phone:720-251-5628
Mailing Address - Fax:
Practice Address - Street 1:7853 E. ARAPAHOE CT,
Practice Address - Street 2:SUITE 3000
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1377
Practice Address - Country:US
Practice Address - Phone:720-251-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW09923164OtherCSW09923164