Healthcare Provider Details

I. General information

NPI: 1225815186
Provider Name (Legal Business Name): MELISSA KAY PAKAS ACLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N PUBLIC SQ
BROWNING MT
59417-5316
US

IV. Provider business mailing address

PO BOX 1349
BROWNING MT
59417-1349
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-3123
  • Fax: 406-338-7653
Mailing address:
  • Phone: 406-845-5215
  • Fax: 406-338-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-62309
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: