Provider Demographics
NPI:1013121029
Name:BOIHEM, MELISSA ANNE (MA, LPC)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ANNE
Last Name:BOIHEM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N TEJON ST
Mailing Address - Street 2:200B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1534
Mailing Address - Country:US
Mailing Address - Phone:719-201-2577
Mailing Address - Fax:
Practice Address - Street 1:19 N TEJON ST
Practice Address - Street 2:200B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1534
Practice Address - Country:US
Practice Address - Phone:719-201-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO532838Medicaid