Provider Demographics
NPI:1386098010
Name:RADDATZ, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RADDATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 ARAPAHOE RD STE 132-1027
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8018
Mailing Address - Country:US
Mailing Address - Phone:303-717-8094
Mailing Address - Fax:720-802-2025
Practice Address - Street 1:2770 ARAPAHOE RD STE 132-1027
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8018
Practice Address - Country:US
Practice Address - Phone:303-717-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0106394101YM0800X
CO0007964101YA0400X
CO.0000946101YA0400X
COMET.1631106H00000X
CO.0001631106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1386098010OtherNPI