Provider Demographics
NPI:1053713297
Name:KALLWEIT, MELISSA (LCPC-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KALLWEIT
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 CENTENNIAL TRL
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-9300
Mailing Address - Country:US
Mailing Address - Phone:720-556-7628
Mailing Address - Fax:
Practice Address - Street 1:2227 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6032
Practice Address - Country:US
Practice Address - Phone:406-299-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional