Provider Demographics
NPI:1194538397
Name:NEITZEL, MELISSA (LPC-IT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:NEITZEL
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 LANCASTER CT
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9536
Mailing Address - Country:US
Mailing Address - Phone:414-573-3135
Mailing Address - Fax:
Practice Address - Street 1:N50W5050 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2158
Practice Address - Country:US
Practice Address - Phone:144-573-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8291-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health