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General NPI Number Information
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NPI Number | 1982272373
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Entity Type | Individual
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Provider Name | MELISA M MCTAGGERT STERNBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 1839 N GOVERNMENT WAY
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3454
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Country | US
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Telephone | 208-797-1162
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Fax | 208-625-2079
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Provider Business Mailing Address
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Address Line | 4371 W MAGRATH DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-0021
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Country | US
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Telephone | 208-797-1162
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Fax | 208-625-2079
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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 | LMSW39646
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 42878
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License Number State | ID
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