Provider Demographics
NPI:1568223709
Name:MCOMBER, MELISSA ANN (LCP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MCOMBER
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11283 W HICKORY DALE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1029
Mailing Address - Country:US
Mailing Address - Phone:208-284-7065
Mailing Address - Fax:
Practice Address - Street 1:1370 CALDWELL BLVD # 4
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1768
Practice Address - Country:US
Practice Address - Phone:208-442-9419
Practice Address - Fax:208-442-9419
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional