Provider Demographics
NPI:1831475011
Name:MISH, M MELISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:MELISSA
Last Name:MISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MELISSA
Other - Last Name:MISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2323 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2627
Mailing Address - Country:US
Mailing Address - Phone:303-244-0752
Mailing Address - Fax:
Practice Address - Street 1:2323 CURTIS ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2627
Practice Address - Country:US
Practice Address - Phone:303-244-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO771104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker