Provider Demographics
NPI:1275359176
Name:SMITH, MELINDA DIANNE (LPC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:DIANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 SANDY SHORE LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7183
Mailing Address - Country:US
Mailing Address - Phone:303-888-8271
Mailing Address - Fax:
Practice Address - Street 1:608 E HARMONY RD STE 205
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3210
Practice Address - Country:US
Practice Address - Phone:970-673-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional