Provider Demographics
NPI:1508332057
Name:MELISSA M MEESKE LLC
Entity Type:Organization
Organization Name:MELISSA M MEESKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-638-8844
Mailing Address - Street 1:6270 LEHMAN DR STE 208
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1470
Mailing Address - Country:US
Mailing Address - Phone:719-661-5572
Mailing Address - Fax:
Practice Address - Street 1:6270 LEHMAN DR STE 208
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1470
Practice Address - Country:US
Practice Address - Phone:719-661-5572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty