Individual
MELISSA MADELYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
591 N 2ND E, REXBURG, ID 83440-3566
(208) 356-6975
Mailing address
140 ALTA NORTH RD, ALTA, WY 83414-4576
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT-8639
ID
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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