Healthcare Provider Details

I. General information

NPI: 1902040017
Provider Name (Legal Business Name): MELISSA GALE MA, LPC, LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GLYNN DRIVE
PARKSTON SD
57366-9605
US

IV. Provider business mailing address

401 W GLYNN DRIVE
PARKSTON SD
57366-9605
US

V. Phone/Fax

Practice location:
  • Phone: 605-928-7961
  • Fax: 605-928-4417
Mailing address:
  • Phone: 605-928-7961
  • Fax: 605-928-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3528
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1773
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSD LPC7143
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: