Healthcare Provider Details

I. General information

NPI: 1649158270
Provider Name (Legal Business Name): MELISSA ANNE KEYES CSW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N 1300 W STE 10
ST GEORGE UT
84770-6468
US

IV. Provider business mailing address

2059 W RIVERS EDGE LN
ST GEORGE UT
84770-1815
US

V. Phone/Fax

Practice location:
  • Phone: 435-429-1219
  • Fax:
Mailing address:
  • Phone: 702-572-5181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: