Individual
MALLYSSA ROSE NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6800 78TH AVE N, BROOKLYN PARK, MN 55445-2758
(612) 314-0349
Mailing address
6740 PLAZA CURV NE, FRIDLEY, MN 55432-4323
(612) 709-2502
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
307186
MN
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
04/18/2025
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