Provider Demographics
NPI:1407823065
Name:BARNES, MELODY LYNN (MSW, LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNN
Last Name:BARNES
Suffix:
Gender:F
Credentials:MSW, LCSW, LAC
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LCSW LAC
Mailing Address - Street 1:PO BOX 4901
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-4901
Mailing Address - Country:US
Mailing Address - Phone:406-926-6360
Mailing Address - Fax:406-721-6901
Practice Address - Street 1:127 N HIGGINS AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4457
Practice Address - Country:US
Practice Address - Phone:406-926-6360
Practice Address - Fax:406-721-6901
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT07119-5OtherBLUE CROSS OF MONTANA
MT1912230160Medicare PIN