Individual
MELISSA WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3144 W BELLTOWER DR, MERIDIAN, ID 83646-4882
(208) 371-4137
Mailing address
3144 W BELLTOWER DR, MERIDIAN, ID 83646-4882
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LAMFT-9147
ID
106H00000X
Marriage & Family Therapist
MFTI-9148
ID
Other
Enumeration date
09/28/2022
Last updated
06/29/2023
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