Provider Demographics
NPI:1740929132
Name:RAYNE-MARTIN, MELISSA LEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEE
Last Name:RAYNE-MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 CLAIRE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-2624
Mailing Address - Country:US
Mailing Address - Phone:208-881-1699
Mailing Address - Fax:
Practice Address - Street 1:211 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4324
Practice Address - Country:US
Practice Address - Phone:208-524-4818
Practice Address - Fax:208-233-0835
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-42198104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker