Provider Demographics
NPI:1245318484
Name:CARRIS, MELISSA JEAN (PHD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:CARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 HORIZON CT
Mailing Address - Street 2:SUITE 368
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8701
Mailing Address - Country:US
Mailing Address - Phone:970-712-9797
Mailing Address - Fax:970-241-9292
Practice Address - Street 1:743 HORIZON CT
Practice Address - Street 2:SUITE 368
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8701
Practice Address - Country:US
Practice Address - Phone:970-712-9797
Practice Address - Fax:970-241-9292
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA103748Medicare PIN