Provider Demographics
NPI:1821420142
Name:BARBOZA, MELINDA MICHELE (LPC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MICHELE
Last Name:BARBOZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HEYBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83336-1300
Mailing Address - Country:US
Mailing Address - Phone:208-878-6270
Mailing Address - Fax:208-878-6272
Practice Address - Street 1:1510 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1850
Practice Address - Country:US
Practice Address - Phone:208-878-6270
Practice Address - Fax:208-788-6272
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health