MEDICARE: MELISSA JO BLEILER MS, LMFT, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1276	WI
2	101YM0800X	Mental Health Counselor	7434	WI

General Provider Information

NPI Number	:	1235702705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JO BLEILER MS, LMFT, LPC

Provider Business Mailing Address
First Line	:	PO BOX 7188
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53707-7188
Country	:	US
Telephone Number	:	608-305-4097
Fax Number	:	608-690-5242

Provider Business Practice Location Address
First Line	:	3902 MILWAUKEE ST # W428
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53707-5001
Country	:	US
Telephone Number	:	608-305-4097
Fax Number	:	608-690-5242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	12/27/2023

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