Individual provider Active NPI

Melissa Ann Leverence, LICSW

  • Clinical Social Worker
  • Moorhead, MN
National Provider Identifier
1639313539
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
19653 Issued in MN
Practice address
2405 8TH St S Ste 200
Moorhead, MN 56560-4200
Phone
(218) 331-4866
Fax
(218) 331-4867
NPI assigned
Apr 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X AP09-524 MN
Mental Health Counselor 101YM0800X 4244 ND
Clinical Social Worker 1041C0700X 19653 MN Primary

Addresses

Primary practice location

2405 8TH St S Ste 200
Moorhead, MN 56560-4200

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 379-1704

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120503000637 ND Practitioner - Clinical Social Worker 2062674211 Reassigns benefits to 1 organization
I20131016000319 MN Practitioner - Clinical Social Worker 2062674211 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

2405 8TH St S
Suite 200
Moorhead, MN 56560-4200
Phone (218) 331-4866

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AP09-524MNMDMental Health Counselor
19653MNMDMusic Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD Clinical CurrentSince Jan 20, 2025 Accepting new patients
Pediatric Therapy Partners, Inc. Clinical CurrentSince May 11, 2020 Accepting new patients
Family Support Services Inc. Mental Health CurrentSince Jan 12, 2025 Accepting new patients
Pediatric Therapy Partners, Inc. PastSince May 1, 2020 Accepting new patients
Prairie St Johns Past Accepting new patients

Locations

305 30th Ave W
Alexandria, MN 56308
Phone (320) 460-8028

7300 147th St W
Ste 600
Apple Valley, MN 55124
Phone (952) 997-3020

13045 Falcon Dr
#100
Brainerd, MN 56425
Phone (218) 203-6282

203 14th St NE
East Grand Forks, MN 56721
Phone (218) 693-2014

114 Main St N
Ste 201B
Hutchinson, MN 55350
Phone (320) 753-0778

2405 8th St S
Ste 200
Moorhead, MN 56560
Phone (218) 331-4866

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

3401 45th St S
#A
Fargo, ND 58104
Phone (701) 356-4384

3401 45th St S
Fargo, ND 58104
Phone (701) 356-4384

3060 Frontier Way S
Fargo, ND 58104
Phone (701) 356-4384

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1639313539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-379-1704",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 8TH ST S STE 200",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565604200",
            "telephone_number": "218-331-4866",
            "fax_number": "218-331-4867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVERENCE",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-23",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "AP09-524",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ND",
            "license": "4244",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.