Melissa Ann Bolger, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

3420 Issued in MN

Practice address

4801 1/2 Nicollet Ave
Minneapolis, MN 55419-5510

Phone

(612) 217-0854

NPI assigned

Jan 11, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 8, 2024 through Jan 8, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Bolger Family Counseling, LLC

  • Clinic/Center
  • Minneapolis, MN
  • NPI 1386494565
  NPD Authorized official
• Washburn Center for Children

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1225136419
  NPD (past)

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1417420548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 1/2 NICOLLET AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554195510",
            "telephone_number": "612-217-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 1/2 NICOLLET AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554195510",
            "telephone_number": "612-217-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLGER",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-11",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Bold
• Anne Boldt, MD
• Reghan Maureen Boldt, MOT, OTR/L, CLT
• David Benjamin Boleen
• Bolger Family Counseling, LLC
• Connie J Bolin, CRNA
• Matthew David Bolin
• Michelle M Bolin, CRNA
• Christine N Boline, APRN
• Karly Anne Boll, MD

• Marriage & Family Therapist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.