Healthcare Provider Details

I. General information

NPI: 1306526728
Provider Name (Legal Business Name): MELISSA SEVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E 3RD ST STE 102
CASPER WY
82601-3200
US

IV. Provider business mailing address

940 E 3RD ST STE 102
CASPER WY
82601-3200
US

V. Phone/Fax

Practice location:
  • Phone: 307-462-4876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-2343
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: