Individual
MELINDA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
323 12TH AVE RD, NAMPA, ID 83686-5014
(208) 463-0212
(208) 461-5452
Mailing address
323 12TH AVE RD, NAMPA, ID 83686-5014
(208) 463-0212
(208) 461-5452
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW1269
ID
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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