Provider Demographics
NPI:1265958417
Name:MELISSA BALENT PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:MELISSA BALENT PSYCHOTHERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BALENT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LAC
Authorized Official - Phone:970-238-2817
Mailing Address - Street 1:2590 WELTON ST STE 200 # 1033
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4268
Mailing Address - Country:US
Mailing Address - Phone:970-238-2817
Mailing Address - Fax:833-222-3726
Practice Address - Street 1:2590 WELTON ST STE 200 # 1033
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4268
Practice Address - Country:US
Practice Address - Phone:970-238-2817
Practice Address - Fax:833-222-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000699101YA0400X
COLPC.0012987101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05621997Medicaid
CO985098Medicaid
CO9000149152Medicaid