Provider Demographics
NPI:1144999087
Name:MELISSA PATTERSON THERAPY PLLC (BOULEVARD THERAPY)
Entity type:Organization
Organization Name:MELISSA PATTERSON THERAPY PLLC (BOULEVARD THERAPY)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADC
Authorized Official - Phone:612-819-4278
Mailing Address - Street 1:317 WAYZATA BLVD E
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1683
Mailing Address - Country:US
Mailing Address - Phone:612-819-4278
Mailing Address - Fax:
Practice Address - Street 1:317 WAYZATA BLVD E
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1683
Practice Address - Country:US
Practice Address - Phone:612-819-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty