Healthcare Provider Details

I. General information

NPI: 1306471354
Provider Name (Legal Business Name): MELISSA ERSKINE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 UNIVERSITY AVE W STE 202
SAINT PAUL MN
55114-1769
US

IV. Provider business mailing address

2388 UNIVERSITY AVE W STE 202
SAINT PAUL MN
55114-1769
US

V. Phone/Fax

Practice location:
  • Phone: 612-293-5124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3157
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: