Healthcare Provider Details

I. General information

NPI: 1497806137
Provider Name (Legal Business Name): MS. MELANIE BOSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 CANYON RD
REDDING CA
96001-5544
US

IV. Provider business mailing address

855 CANYON RD
REDDING CA
96001-5544
US

V. Phone/Fax

Practice location:
  • Phone: 530-232-1401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: