Provider Demographics
NPI:1689224503
Name:RACETTE, MELISA ROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISA
Middle Name:ROSE
Last Name:RACETTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MELISA
Other - Middle Name:ROSE
Other - Last Name:OBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1802 CHAPEL HILLS DR STE G
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3736
Mailing Address - Country:US
Mailing Address - Phone:719-203-2894
Mailing Address - Fax:719-982-7845
Practice Address - Street 1:1802 CHAPEL HILLS DR STE G
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3736
Practice Address - Country:US
Practice Address - Phone:719-203-2894
Practice Address - Fax:719-982-7845
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0103600101YM0800X
COPSY.0005533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health