Provider Demographics
NPI:1891109401
Name:BOFENKAMP, MELISSA (LPCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BOFENKAMP
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 GIRARD AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3188
Mailing Address - Country:US
Mailing Address - Phone:612-529-2040
Mailing Address - Fax:612-529-3849
Practice Address - Street 1:2060 CENTRE POINTE BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55120-1269
Practice Address - Country:US
Practice Address - Phone:651-774-0011
Practice Address - Fax:651-774-0606
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional