=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356631634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELISSA NEFF PHD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2011
-----------------------------------------------------
Last Update Date | 07/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 S RUSSELL ST SUITE B110
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-370-2380
-----------------------------------------------------
Fax | 406-721-5072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 S RUSSELL ST STE B110
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-8574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-370-2380
-----------------------------------------------------
Fax | 406-721-5072
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | MELISSA NEFF
-----------------------------------------------------
Credential | PHD, PLLC
-----------------------------------------------------
Telephone | 406-370-2380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 398
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------