Provider Demographics
NPI:1053562322
Name:WITTLAND, MELISSA ANN (PLMHP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:WITTLAND
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13906 GOLD CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2335
Mailing Address - Country:US
Mailing Address - Phone:402-932-6500
Mailing Address - Fax:402-932-6504
Practice Address - Street 1:13906 GOLD CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2335
Practice Address - Country:US
Practice Address - Phone:402-932-6500
Practice Address - Fax:402-932-6504
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health