Healthcare Provider Details

I. General information

NPI: 1750571063
Provider Name (Legal Business Name): MELISSA M GARTNER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 31ST AVE SW
MINOT ND
58701-7036
US

IV. Provider business mailing address

1633 MAIN ST S
MINOT ND
58701-6361
US

V. Phone/Fax

Practice location:
  • Phone: 701-707-1383
  • Fax:
Mailing address:
  • Phone: 701-707-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number592-11-1-07-192
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier54523
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: