Provider Demographics
NPI:1972398386
Name:PAUL, MELISSA MARIE (MSCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:PAUL
Suffix:
Gender:
Credentials:MSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 E MILITARY AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5477
Mailing Address - Country:US
Mailing Address - Phone:402-205-8550
Mailing Address - Fax:800-863-0042
Practice Address - Street 1:1835 E MILITARY AVE STE 111
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5477
Practice Address - Country:US
Practice Address - Phone:402-205-8550
Practice Address - Fax:800-863-0042
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty