Provider Demographics
NPI:1063796092
Name:PRESTON, MELISSA CLAIRE (MA, NCC, RD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CLAIRE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:MA, NCC, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 LINCOLN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2725
Mailing Address - Country:US
Mailing Address - Phone:303-489-9269
Mailing Address - Fax:
Practice Address - Street 1:975 LINCOLN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2725
Practice Address - Country:US
Practice Address - Phone:303-489-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO933352133V00000X
CO103523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered