=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124591771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA MARIE HENBEST LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2019
-----------------------------------------------------
Last Update Date | 02/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 296 W. SUNSET AVE STE 15
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83815-8366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-666-0357
-----------------------------------------------------
Fax | 208-666-0468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 296 W. SUNSET AVE STE 15
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83815-8366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-666-0357
-----------------------------------------------------
Fax | 208-666-0468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | SE-203170
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------