Provider Demographics
NPI:1548768146
Name:ULIBARRI, MELLISA ANN
Entity Type:Individual
Prefix:
First Name:MELLISA
Middle Name:ANN
Last Name:ULIBARRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELLISA
Other - Middle Name:ANN
Other - Last Name:ULIBARRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:6711 PASSING SKY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3876
Mailing Address - Country:US
Mailing Address - Phone:719-321-2565
Mailing Address - Fax:
Practice Address - Street 1:6711 PASSING SKY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3876
Practice Address - Country:US
Practice Address - Phone:719-321-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor