Healthcare Provider Details

I. General information

NPI: 1659805984
Provider Name (Legal Business Name): MELISSA DEHOFF M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-1050
  • Fax:
Mailing address:
  • Phone: 315-462-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP108662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: