Healthcare Provider Details

I. General information

NPI: 1750486593
Provider Name (Legal Business Name): MELISSA STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 11TH AVE
GREELEY CO
80631-3835
US

IV. Provider business mailing address

1306 11TH AVE
GREELEY CO
80631-3835
US

V. Phone/Fax

Practice location:
  • Phone: 970-347-2120
  • Fax: 970-353-3906
Mailing address:
  • Phone: 970-347-2120
  • Fax: 970-353-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: