Healthcare Provider Details

I. General information

NPI: 1558660357
Provider Name (Legal Business Name): MELISSA JUNE HURAY LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 NORTH CENTRAL AVENUE
DULUTH MN
55807
US

IV. Provider business mailing address

326 NORTH CENTRAL AVENUE
DULUTH MN
55807
US

V. Phone/Fax

Practice location:
  • Phone: 218-341-3063
  • Fax:
Mailing address:
  • Phone: 218-341-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302244
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: