Healthcare Provider Details

I. General information

NPI: 1235702705
Provider Name (Legal Business Name): MELISSA JO BLEILER MS, LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 MILWAUKEE ST # W428
MADISON WI
53707-5001
US

IV. Provider business mailing address

PO BOX 7188
MADISON WI
53707-7188
US

V. Phone/Fax

Practice location:
  • Phone: 608-305-4097
  • Fax: 608-690-5242
Mailing address:
  • Phone: 608-305-4097
  • Fax: 608-690-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7434
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1276
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: