Amy Elizabeth Mellum, LICSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

17145 Issued in MN

Practice address

311 Ramsey St., Suite 205
St. Paul, MN 55102

Phone

(651) 262-9726

Fax

(651) 294-2347

NPI assigned

Dec 10, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Group practices

Lyn-Lake Psychotherapy and Wellness LTDGroup PAC ID 9638581291, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Lyn-Lake Psychotherapy and Wellness LTD.

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1609355163

  Mental Health

  Medicare reassignment Care Compare group NPD
• Bushman Psychological Services LLC

  • Mental Health Counselor
  • Burnsville, MN
  • NPI 1861580607
  NPD (past)
• Community Drug & Alcohol Services Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Burnsville, MN
  • NPI 1528145638
  NPD (past)
• Community Drug & Alcohol Services Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Burnsville, MN
  • NPI 1548341688
  NPD (past)

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332892800000",
    "number": "1285817528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 SEMINARY AVE.",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55104",
            "telephone_number": "651-262-9726",
            "fax_number": "651-294-2347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 RAMSEY ST., SUITE 205",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55102",
            "telephone_number": "651-262-9726",
            "fax_number": "651-294-2347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLUM",
        "first_name": "AMY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-10",
        "last_updated": "2012-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "17145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "221928100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "09B85ME",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP88034",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Meller, MD
• Morgan Christine Mellesmoen, LICSW, LADC
• Alison Elizabeth Mellin, PH.D., L.P.
• Andrew Foster Mellin, MD
• Marilyn F Mellor, MD
• Laura A Melms, DNP
• Alan Jason Melnychuk, MD
• Elvina Memetova, CHW
• Memorial Blood Centers
• Kathleen Menacher, LPN

• Mental Health Counselor in St. Paul, MN
• Providers in St. Paul, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.