Healthcare Provider Details

I. General information

NPI: 1376274332
Provider Name (Legal Business Name): MELANIE PILOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11720 W LILIUM ST
STAR ID
83669-6258
US

IV. Provider business mailing address

11720 W LILIUM ST
STAR ID
83669-6258
US

V. Phone/Fax

Practice location:
  • Phone: 208-565-7117
  • Fax:
Mailing address:
  • Phone: 208-565-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-8459
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: