Healthcare Provider Details

I. General information

NPI: 1972985141
Provider Name (Legal Business Name): MELISSA ANN KINNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA LAWRENCE

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8020
  • Fax: 970-495-7686
Mailing address:
  • Phone: 970-495-8020
  • Fax: 970-495-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-09157
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925713
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: