Provider Demographics
NPI:1114078383
Name:LOSEE, MELINDA CAROLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:CAROLE
Last Name:LOSEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RANGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8889
Mailing Address - Country:US
Mailing Address - Phone:307-587-7877
Mailing Address - Fax:307-587-7877
Practice Address - Street 1:2 RANGEVIEW DR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8889
Practice Address - Country:US
Practice Address - Phone:307-587-7877
Practice Address - Fax:307-587-7877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117464902Medicaid
WY9136Medicare ID - Type Unspecified