Provider Demographics
NPI:1770124679
Name:GEORGE, MELISSA RW (PHD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RW
Last Name:GEORGE
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 1:700 E DRAKE RD APT B3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4617
Mailing Address - Country:US
Mailing Address - Phone:574-315-8968
Mailing Address - Fax:
Practice Address - Street 1:405 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1058
Practice Address - Country:US
Practice Address - Phone:970-658-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist