Healthcare Provider Details

I. General information

NPI: 1871345736
Provider Name (Legal Business Name): MELISSA BURNS LCPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 N MERIDIAN RD STE 213
KALISPELL MT
59901-3508
US

IV. Provider business mailing address

550 PAPA LN
KALISPELL MT
59901-8488
US

V. Phone/Fax

Practice location:
  • Phone: 406-407-2577
  • Fax:
Mailing address:
  • Phone: 406-407-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA L BURNS
Title or Position: COUNSELOR
Credential: LCPC
Phone: 406-407-2577