MEDICARE: MS. MELINDA ANN SMITH LCSW

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
1	1041C0700X	Clinical Social Worker	157	MT
2	1041C0700X	Clinical Social Worker	6469	ND
3	1041C0700X	Clinical Social Worker	LCSW-1521	WY
4	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-157	MT

General Provider Information

NPI Number	:	1265449805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA ANN SMITH LCSW

Provider Business Mailing Address
First Line	:	9801 VALLEY GROVE DR #D
Second Line	:
City	:	LOLO
State	:	MT
Zip	:	59847
Country	:	US
Telephone Number	:	406-273-4633
Fax Number	:	406-273-4707

Provider Business Practice Location Address
First Line	:	9801 VALLEY GROVE DR #D
Second Line	:
City	:	LOLO
State	:	MT
Zip	:	59847
Country	:	US
Telephone Number	:	406-273-4633
Fax Number	:	406-273-4707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	06/02/2023

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