Provider Demographics
NPI:1265449805
Name:SMITH, MELINDA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:SMITH
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9801 VALLEY GROVE DR #D
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847
Mailing Address - Country:US
Mailing Address - Phone:406-273-4633
Mailing Address - Fax:406-273-4707
Practice Address - Street 1:9801 VALLEY GROVE DR #D
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847
Practice Address - Country:US
Practice Address - Phone:406-273-4633
Practice Address - Fax:406-273-4707
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1571041C0700X
ND64691041C0700X
WYLCSW-15211041C0700X
MTBBH-LCSW-LIC-1571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical