Healthcare Provider Details

I. General information

NPI: 1942994116
Provider Name (Legal Business Name): MELANIE JANE BECIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2596 N STOKESBERRY PL
MERIDIAN ID
83646-6114
US

IV. Provider business mailing address

5905 N BRIGHTON AVE
GARDEN CITY ID
83714-1238
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-1636
  • Fax:
Mailing address:
  • Phone: 503-347-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8208
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8208
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8331599
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8331599
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: