Provider Demographics
NPI:1558052241
Name:HOLEN, MELISSA RAYE (MS, LAPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAYE
Last Name:HOLEN
Suffix:
Gender:F
Credentials:MS, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 SOURIS ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0925
Mailing Address - Country:US
Mailing Address - Phone:701-400-0928
Mailing Address - Fax:
Practice Address - Street 1:919 S 7TH ST STE 303
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5835
Practice Address - Country:US
Practice Address - Phone:701-712-3290
Practice Address - Fax:701-712-3294
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1287-5-15-23A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional