MEDICARE: MRS. DANIELLE MARIE MELBOUCI LPC

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	101YM0800X	Mental Health Counselor	2892	CO
2	101YP2500X	Professional Counselor	LC7408	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11365234	OTHER	CO	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821010919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE MARIE MELBOUCI LPC

Provider Business Mailing Address
First Line	:	10409 EASTERDAY RD
Second Line	:
City	:	MYERSVILLE
State	:	MD
Zip	:	21773-8620
Country	:	US
Telephone Number	:	240-367-9842
Fax Number	:	720-452-0227

Provider Business Practice Location Address
First Line	:	10409 EASTERDAY RD
Second Line	:
City	:	MYERSVILLE
State	:	MD
Zip	:	21773-8620
Country	:	US
Telephone Number	:	240-367-9842
Fax Number	:	720-452-0227

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	01/27/2025

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