Provider Demographics
NPI:1780229567
Name:EDMONDS, MELANIE (LMFT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2526
Mailing Address - Country:US
Mailing Address - Phone:612-823-6837
Mailing Address - Fax:
Practice Address - Street 1:3217 HENNEPIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4695
Practice Address - Country:US
Practice Address - Phone:612-460-7098
Practice Address - Fax:855-384-1883
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty