Provider Demographics
NPI:1568154144
Name:THOMPSON, MELANIE ANNE (PCLC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 BOOTHILL CT STE 2&3
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7214
Mailing Address - Country:US
Mailing Address - Phone:406-600-5007
Mailing Address - Fax:
Practice Address - Street 1:2216 BOOTHILL CT STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7215
Practice Address - Country:US
Practice Address - Phone:406-600-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-50741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional