Provider Demographics
NPI:1891171088
Name:CHALOM, MELISSA JIMENEZ (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JIMENEZ
Last Name:CHALOM
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 E FRATELLO ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9336
Mailing Address - Country:US
Mailing Address - Phone:208-409-3799
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST
Practice Address - Street 2:SUITE 184
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1260
Practice Address - Country:US
Practice Address - Phone:208-409-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional