Healthcare Provider Details

I. General information

NPI: 1538673769
Provider Name (Legal Business Name): MELISSA MYERS SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 MCCLURE AVE
NAMPA ID
83651-2025
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-7654
  • Fax: 208-345-3502
Mailing address:
  • Phone: 208-495-1011
  • Fax: 208-495-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1538673769
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: