Provider Demographics
NPI:1750931234
Name:TROST, MELANIE ROSE (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROSE
Last Name:TROST
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3510
Mailing Address - Country:US
Mailing Address - Phone:406-370-4140
Mailing Address - Fax:
Practice Address - Street 1:2308 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3510
Practice Address - Country:US
Practice Address - Phone:406-370-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT381161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical