Healthcare Provider Details

I. General information

NPI: 1205066081
Provider Name (Legal Business Name): MELISSA JOECKS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 YELLOWSTONE AVE STE A
WEST YELLOWSTONE MT
59758-9507
US

IV. Provider business mailing address

440 YELLOWSTONE AVE STE A
WEST YELLOWSTONE MT
59758-9507
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-1111
  • Fax:
Mailing address:
  • Phone: 406-222-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-1410
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: