Healthcare Provider Details

I. General information

NPI: 1396962601
Provider Name (Legal Business Name): MELISSA FLORES-FIORAVANTI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E LAKE ST
MINNEAPOLIS MN
55407-1547
US

IV. Provider business mailing address

720 E LAKE ST
MINNEAPOLIS MN
55407-1547
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-4200
  • Fax: 612-871-1058
Mailing address:
  • Phone: 651-379-4200
  • Fax: 612-871-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1617
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: