Healthcare Provider Details

I. General information

NPI: 1669302832
Provider Name (Legal Business Name): MELISSA HAKE LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13654 XAVIER LN STE 201
BROOMFIELD CO
80023-3608
US

IV. Provider business mailing address

758 POPE CT
ERIE CO
80516-6522
US

V. Phone/Fax

Practice location:
  • Phone: 720-523-1067
  • Fax:
Mailing address:
  • Phone: 763-479-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0022462
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: