Individual
MS. MELISSA ANN BRIGHTSTAR RUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
112 12TH AVE RD, NAMPA, ID 83686-5051
(208) 465-5433
Mailing address
3123 WINSOME RD, BOISE, ID 83702-0951
(208) 344-4284
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC3759
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010159326
REGENCE BLUE SHIELD
ID
Enumeration date
04/24/2007
Last updated
07/08/2007
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