Provider Demographics
NPI:1558429506
Name:SAVAGE, MELISSA DIANE (LMFT, RPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LMFT, RPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DIANE
Other - Last Name:NAVOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1833 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2424
Mailing Address - Country:US
Mailing Address - Phone:651-436-8294
Mailing Address - Fax:
Practice Address - Street 1:1833 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2424
Practice Address - Country:US
Practice Address - Phone:763-421-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP40291OtherHEALTH PARTNERS
MN717620100Medicaid
MN773S2SAOtherBLUE CROSS BLUE SHIELD