Healthcare Provider Details

I. General information

NPI: 1417075334
Provider Name (Legal Business Name): MELISSA MARTIN FRIESEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 W COLFAX AVE
LAKEWOOD CO
80215-3918
US

IV. Provider business mailing address

6264 E PEAKVIEW AVE
CENTENNIAL CO
80111-4325
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5279
  • Fax:
Mailing address:
  • Phone: 303-741-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number766
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: