Provider Demographics
NPI:1780042804
Name:MELLUM, ABBIGAIL (BS, LAC)
Entity type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:
Last Name:MELLUM
Suffix:
Gender:F
Credentials:BS, LAC
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 82
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59063-0082
Mailing Address - Country:US
Mailing Address - Phone:406-794-2003
Mailing Address - Fax:
Practice Address - Street 1:208 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-3988
Practice Address - Country:US
Practice Address - Phone:406-794-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-16223101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)