MELISSA A DETRIE LPC, SAC-IT
NPI 1205525904
Counselor - Professional in Green Bay, WI

Q: What is Melissa Detrie's NPI number?

The NPI number for Melissa Detrie is 1205525904. It was assigned to this individual provider in the NPPES registry on May 8, 2023.

Q: What is Melissa Detrie's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Melissa Detrie was last updated on April 17, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since May 08, 2023PECOS Enrolled

2640 W POINT RD, GREEN BAY, WI 54304(920) 490-3875 Get Directions Write a Review

NPPES record last updated: April 17, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 17, 2026, Jun 19, 2025, Jul 9, 2024 and 2 more (5 updates tracked since 2023).

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About Melissa A Detrie Lpc, Sac-it NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MELISSA A DETRIE LPC, SAC-IT (NPI 1205525904) is an individual professional provider in Green Bay, Wisconsin, licensed in Wisconsin (11880-125) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205525904

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameMELISSA A DETRIECredential: LPC, SAC-IT

Location Address2640 W POINT RDGreen Bay, WI 54304-1344

Mailing Address1566 W Mason St Ste 5Green Bay, WI 54303-2274 · (920) 212-1612

Phone(920) 490-3875

Sole ProprietorNo

Enumeration DateMay 8, 2023

Last NPPES UpdateApril 17, 20265 updates tracked since enumeration

NPPES CertifiedApril 17, 2026

✔ NPI 1205525904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

Licenses✔ Licensed in WI · 11880-125✔ Licensed in MI · 6401225600

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 20395-130 (WI)

2640 W POINT RD, Green Bay, WI 54304

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Medica, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Melissa A Detrie Lpc, Sac-it is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. SCOTT D LALONDE CSAC

Counselor (Addiction (Substance Use Disorder))