Provider Demographics
NPI:1396577912
Name:MCQUISTON, MELANIE (LPC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MCQUISTON
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 1:451 BOARDWALK DR APT 451
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3222
Mailing Address - Country:US
Mailing Address - Phone:313-580-3597
Mailing Address - Fax:
Practice Address - Street 1:199 SUMMER HAVEN DR
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-9103
Practice Address - Country:US
Practice Address - Phone:719-602-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional