Healthcare Provider Details

I. General information

NPI: 1003738089
Provider Name (Legal Business Name): JESSIE MELISON PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 GRAND AVE UNIT 114
PAONIA CO
81428-5093
US

IV. Provider business mailing address

PO BOX 1012
PAONIA CO
81428-1012
US

V. Phone/Fax

Practice location:
  • Phone: 970-355-9130
  • Fax:
Mailing address:
  • Phone: 970-355-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSIE MELISON
Title or Position: OWNER
Credential: LCSW
Phone: 970-355-9130