Provider Demographics
NPI:1114810520
Name:MELISSA HOLTROP LLC
Entity type:Organization
Organization Name:MELISSA HOLTROP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:HOLTROP
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-403-4028
Mailing Address - Street 1:752 BLANDING BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:752 BLANDING BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8710
Practice Address - Country:US
Practice Address - Phone:904-933-1260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty