Individual
MELISSA WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1276 W RIVER ST STE 100, BOISE, ID 83702-7083
(208) 338-4699
Mailing address
1276 W RIVER ST STE 100, BOISE, ID 83702-7083
(208) 338-4699
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACC.0020956
CO
101YP2500X
Professional Counselor
Primary
LCPC9503
ID
Other
Enumeration date
11/15/2019
Last updated
08/30/2023
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