Provider Demographics
NPI:1043495690
Name:COLLINS, MELISSA SUE (LAC, LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N 1ST ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2556
Mailing Address - Country:US
Mailing Address - Phone:406-531-7164
Mailing Address - Fax:
Practice Address - Street 1:302 N 1ST ST STE 4A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2556
Practice Address - Country:US
Practice Address - Phone:406-531-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1169101YA0400X
MT9831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)