Provider Demographics
NPI:1275702946
Name:ANSTINE, MELISSA A (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:ANSTINE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 BRYDEN CT
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4929
Mailing Address - Country:US
Mailing Address - Phone:208-305-9360
Mailing Address - Fax:
Practice Address - Street 1:3328 BRYDEN CT
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4929
Practice Address - Country:US
Practice Address - Phone:208-305-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-437381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical