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General NPI Number Information
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NPI Number | 1013328103
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Entity Type | Individual
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Provider Name | MELANIE RICHARDSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 1188 W SPORTSPLEX DR STE 203
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City | KAYSVILLE
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State | UT
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Zip | 84037-6817
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Country | US
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Telephone | 801-719-7737
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Fax | 888-887-9784
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Provider Business Mailing Address
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Address Line | 2184 CHANNING WAY # 157
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8034
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Country | US
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Telephone | 801-719-7737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW-36133
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-33744
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-36133
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117243-3501
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License Number State | UT
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