Provider Demographics
NPI:1912230160
Name:MELODY BARNES, LCSW LAC, INC.
Entity Type:Organization
Organization Name:MELODY BARNES, LCSW LAC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LAC
Authorized Official - Phone:406-926-6360
Mailing Address - Street 1:PO BOX 4901
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-4901
Mailing Address - Country:US
Mailing Address - Phone:406-926-6360
Mailing Address - Fax:406-721-6901
Practice Address - Street 1:127 N. HIGGINS
Practice Address - Street 2:SUITE 302
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4457
Practice Address - Country:US
Practice Address - Phone:406-926-6360
Practice Address - Fax:406-721-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT423101YA0400X
MT6991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT071195OtherBLUE CROSS OF MONTANA
MT0000503737Medicaid
MT071195OtherBCBS
MT0138957Medicaid
MTM000050250Medicare PIN