Provider Demographics
NPI:1063849149
Name:ANDERSON, MELISSA M (LMFT, LADC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 ROBERT ST S APT 444
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4491
Mailing Address - Country:US
Mailing Address - Phone:612-850-3568
Mailing Address - Fax:
Practice Address - Street 1:10 7TH AVE N
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8842
Practice Address - Country:US
Practice Address - Phone:612-244-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302625101YA0400X
MN1727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)