Provider Demographics
NPI:1720485881
Name:NELSON, MELISSA (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 DESERT WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7903
Mailing Address - Country:US
Mailing Address - Phone:720-334-8258
Mailing Address - Fax:720-685-5404
Practice Address - Street 1:13653 EAST 104TH AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022
Practice Address - Country:US
Practice Address - Phone:720-334-8258
Practice Address - Fax:720-685-5404
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional