Provider Demographics
NPI:1598109266
Name:UHL, MELISSA (CADC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:UHL
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 RIMVIEW LN W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3610
Mailing Address - Country:US
Mailing Address - Phone:208-789-4936
Mailing Address - Fax:
Practice Address - Street 1:284 MARTIN ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-733-7186
Practice Address - Fax:208-733-7171
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)