Provider Demographics
NPI:1285962548
Name:LEE-ECKES, MELISSA A (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:LEE-ECKES
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 MAIN AVE SUITE 102
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-443-0642
Mailing Address - Fax:218-512-0180
Practice Address - Street 1:1506 MAIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3053
Practice Address - Country:US
Practice Address - Phone:218-443-0642
Practice Address - Fax:218-512-0180
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN161231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical