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General NPI Number Information
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NPI Number | 1245556802
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Entity Type | Individual
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Provider Name | MELODY ANN DIDISSE M.A., LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 8199 E 1ST AVE
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City | DENVER
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State | CO
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Zip | 80230-7163
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Country | US
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Telephone | 303-731-8977
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Fax |
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Provider Business Mailing Address
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Address Line | 2128 SUMMERFIELD DR
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City | CASTLE ROCK
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State | CO
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Zip | 80104-2338
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Country | US
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Telephone | 714-824-7969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 58406
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CO.0001435
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License Number State | CO
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