Provider Demographics
NPI:1891153516
Name:WOODY, MELISSA KRISTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KRISTIN
Last Name:WOODY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:KRISTIN
Other - Last Name:COMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3533 POWDERKEG DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-9183
Mailing Address - Country:US
Mailing Address - Phone:970-978-9750
Mailing Address - Fax:970-330-5549
Practice Address - Street 1:3533 POWDERKEG DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-9183
Practice Address - Country:US
Practice Address - Phone:970-978-9750
Practice Address - Fax:970-330-5549
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical