Individual
MR. CHARLES ALVIN MELICK III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW - 37691
Contact information
Practice address
2275 W BROADWAY ST, STE. G, IDAHO FALLS, ID 83402-2902
(208) 524-7400
(208) 524-8004
Mailing address
1885 GALLUP ST, IDAHO FALLS, ID 83404-5606
(801) 669-4600
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCSW-37691
ID
Other
Enumeration date
07/16/2014
Last updated
04/03/2019
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