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NPI Code Detail

MEDICARE: MS. MELISSA CAROL DURHAM M.S., L.P.C.

MEDICARE: MS. MELISSA CAROL DURHAM M.S., L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor4308ID

General Provider Information

NPI Number : 1184944209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MELISSA CAROL DURHAM M.S., L.P.C.
Provider Business Mailing Address
First Line : 4636 N HACIENDA AVE
Second Line :
City : BOISE
State : ID
Zip : 83703-6425
Country : US
Telephone Number : 208-230-1787
Fax Number : 208-455-8622
Provider Business Practice Location Address
First Line : 1276 W RIVER ST STE 100
Second Line :
City : BOISE
State : ID
Zip : 83702-7083
Country : US
Telephone Number : 208-338-4699
Fax Number : 208-322-4722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2010
Last Update Date : 06/11/2010

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