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General NPI Number Information
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NPI Number | 1710200951
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Entity Type | Individual
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Provider Name | MELISSA DIANE PFENNING M.ED., LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 1616 E SELTICE WAY STE 213
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City | POST FALLS
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State | ID
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Zip | 83835-0000
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Country | US
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Telephone | 208-699-0679
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3620
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City | POST FALLS
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State | ID
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Zip | 83877-0018
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Country | US
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Telephone | 208-699-0679
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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 | LCPC 4662
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License Number State | ID
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