Healthcare Provider Details

I. General information

NPI: 1467907485
Provider Name (Legal Business Name): MELBOURNE COUNSELING LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 09/21/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7853 E. ARAPAHOE CT, SUITE 3000
CENTENNIAL CO
80112-1377
US

IV. Provider business mailing address

7853 E. ARAPAHOE CT, SUITE 3000
CENTENNIAL CO
80112-1377
US

V. Phone/Fax

Practice location:
  • Phone: 720-251-5628
  • Fax:
Mailing address:
  • Phone: 720-251-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE ANN LANE
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: MSW
Phone: 720-251-5628