Provider Demographics
NPI:1669991071
Name:STAVE, MELISSA LEE (MS, LADC, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:STAVE
Suffix:
Gender:F
Credentials:MS, LADC, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 JEFFERSON ST S
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1534
Mailing Address - Country:US
Mailing Address - Phone:701-367-5276
Mailing Address - Fax:888-304-1685
Practice Address - Street 1:314 JEFFERSON ST S
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1534
Practice Address - Country:US
Practice Address - Phone:218-631-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305104101YA0400X
MNCC00815101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty