Provider Demographics
NPI:1679906291
Name:WALDEN, MELISSA J (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:WALDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 FJORD PASS
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-3631
Mailing Address - Country:US
Mailing Address - Phone:608-843-7055
Mailing Address - Fax:
Practice Address - Street 1:1822 FJORD PASS
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-3631
Practice Address - Country:US
Practice Address - Phone:608-843-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5147-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional