Provider Demographics
NPI:1649248287
Name:JOCKHECK, MELISSA (LPC MH QMHP CDVCIII)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JOCKHECK
Suffix:
Gender:F
Credentials:LPC MH QMHP CDVCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E SIOUX AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3396
Mailing Address - Country:US
Mailing Address - Phone:605-224-7247
Mailing Address - Fax:605-224-5660
Practice Address - Street 1:740 E SIOUX AVE STE 110
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3396
Practice Address - Country:US
Practice Address - Phone:605-224-7247
Practice Address - Fax:605-224-5660
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH101YP2500X
SDCDVCIII101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575460Medicaid
SD4997487OtherBCBS
SD8729062OtherDAKOTACARE