Provider Demographics
NPI:1386878692
Name:QUAM, MELISSA MAE (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MAE
Last Name:QUAM
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-8800
Mailing Address - Fax:
Practice Address - Street 1:5255 MEMBERS PKWY NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8381
Practice Address - Country:US
Practice Address - Phone:507-218-3701
Practice Address - Fax:507-258-5503
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist