Healthcare Provider Details

I. General information

NPI: 1679141402
Provider Name (Legal Business Name): MELINDA HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E DEER FLAT RD
KUNA ID
83634-1323
US

IV. Provider business mailing address

145 E DEER FLAT RD
KUNA ID
83634-1323
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-9001
  • Fax: 208-922-3778
Mailing address:
  • Phone: 208-922-9001
  • Fax: 208-922-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-8183
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: