Melissa A Detrie, LPC, SAC-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

11880-125 Issued in WI

Practice address

2640 W Point Rd
Green Bay, WI 54304-1344

Phone

(920) 490-3875

NPI assigned

May 8, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kimberley Welk and Associates, LLC

  • Marriage & Family Therapist
  • Green Bay, WI
  • NPI 1487075214
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776384000000",
    "number": "1205525904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1566 W MASON ST STE 5",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032274",
            "telephone_number": "920-212-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 W POINT RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543041344",
            "telephone_number": "920-490-3875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRIE",
        "first_name": "MELISSA",
        "middle_name": "A",
        "credential": "LPC, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401225600",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "11880-125",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "20395-130",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi L Destree, MA
• Katrina Lynn Destree, M.D.
• Nathan Reid Deterville, PT, DPT
• Karen A Detrick, COTA
• Clarissa Detrie, MSW
• Sara Dettlaff, APNP
• Shanna E Devos, APSW, SW
• Amy Deweert, COTA
• Diane Lynn Dewinter, LPN
• Lynn Dewitt, PTA

• Professional Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.