Healthcare Provider Details

I. General information

NPI: 1649548033
Provider Name (Legal Business Name): MELINDA SUE NEWMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MONTANA ST
DILLON MT
59725-3353
US

IV. Provider business mailing address

180 ARABIAN LN
DILLON MT
59725-8315
US

V. Phone/Fax

Practice location:
  • Phone: 406-925-3010
  • Fax:
Mailing address:
  • Phone: 406-925-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1598
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1598
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: