Melissa Grace Nichols
Individual provider Active NPI Marriage & Family Therapist · Wayzata, MN
NPI 1508996786 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1508996786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 1058 (MN)
- Practice address
- 18322 Minnetonka Blvd Ste C
Wayzata, MN 55391-3258 - Phone
- (952) 475-2818
- Fax
- (952) 475-3356
- NPI assigned
- Mar 6, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241018000659 | MN | Practitioner - Marriage and Family Therapist | 1355436320 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Attachment and Family Center of Minnesota | Marriage & Family Therapist | Current |
Accepting new patients |
Locations
102 N Chestnut St
Chaska, MN 55318
Phone (952) 234-4632
18322 Minnetonka Blvd
Ste C
Wayzata, MN 55391
Phone (952) 475-2818
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1058 | MN | Yes |
Addresses
Primary practice location
18322 Minnetonka Blvd Ste C
Wayzata, MN 55391-3258
Mailing address
18322 Minnetonka Blvd Ste C
Wayzata, MN 55391-3258
Phone (952) 475-2818
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- John A Ness
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All providers in Wayzata, MN · Marriage & Family Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.