Healthcare Provider Details

I. General information

NPI: 1598164907
Provider Name (Legal Business Name): MELANIE ANN NEUMANN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 12/04/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 S. COLUMBIA RD
GRAND FORKS ND
58201
US

IV. Provider business mailing address

PO BOX 13780
GRAND FORKS ND
58208
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6697
  • Fax:
Mailing address:
  • Phone: 701-780-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 10979
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number957-6-15-18-317
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number957-6-15-18-317
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: