MEDICARE: MELISSA R RIESLING MA, LPC

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	4889	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4889	OTHER	CO	PROFESSIONAL COUNSELOR LICENSE

General Provider Information

NPI Number	:	1275875676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA R RIESLING MA, LPC

Provider Business Mailing Address
First Line	:	20431 BALD MOUNTAIN CT
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-9310
Country	:	US
Telephone Number	:	719-359-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1864 WOODMOOR DR
Second Line	:	SUITE 216
City	:	MONUMENT
State	:	CO
Zip	:	80132-9095
Country	:	US
Telephone Number	:	719-359-2525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2013
Last Update Date	:	01/03/2017

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