Healthcare Provider Details

I. General information

NPI: 1649100025
Provider Name (Legal Business Name): MORGAN CHRISTINE MELLESMOEN LICSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 GRAND AVE
SAINT PAUL MN
55105-2633
US

IV. Provider business mailing address

518 PRAIRIE DR N
HUDSON WI
54016-1171
US

V. Phone/Fax

Practice location:
  • Phone: 612-979-2276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number307206
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32978
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: