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General NPI Number Information
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NPI Number | 1972800100
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Entity Type | Individual
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Provider Name | MELISSA ANN KLEMM NCC,LPC-MH,LAC,QMHP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 1304 MAIN AVE S
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City | BROOKINGS
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State | SD
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Zip | 57006
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Country | US
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Telephone | 605-999-6162
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Fax | 605-942-7300
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Provider Business Mailing Address
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Address Line | 1304 MAIN AVE S
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City | BROOKINGS
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State | SD
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Zip | 57006-3841
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Country | US
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Telephone | 605-999-6162
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Fax | 605-942-7300
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCMH2238
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LAC07111332
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCMH2238
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License Number State | SD
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