Provider Demographics
NPI:1457966244
Name:ODENDAHL, MELISSA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ODENDAHL
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 1:1250 COLORADO BLVD APT 311
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3634
Mailing Address - Country:US
Mailing Address - Phone:712-830-0857
Mailing Address - Fax:
Practice Address - Street 1:13659 E 104TH AVE UNIT 500
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9409
Practice Address - Country:US
Practice Address - Phone:720-339-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health