MEDICARE: MELTON COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1215783873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELTON COUNSELING LLC

Provider Business Mailing Address
First Line	:	1305 HILLCREST AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2147 N ACADEMY BLVD STE 3
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1507
Country	:	US
Telephone Number	:	719-201-7953
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACKIE HELEN GALLEGOS
Credential	:	LPC
Telephone Number	:	719-201-7953

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	04/25/2024

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