Provider Demographics
NPI:1568213072
Name:HALL, MELISSA F (LSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:HALL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 BLIZZARD VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7157
Mailing Address - Country:US
Mailing Address - Phone:813-340-0900
Mailing Address - Fax:
Practice Address - Street 1:2116 HOLLOW BROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1443
Practice Address - Country:US
Practice Address - Phone:719-249-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009924860104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker