Provider Demographics
NPI:1386079283
Name:OWENS, MELISSA MARY (LMSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MARY
Last Name:OWENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 MADEIRA LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6700
Mailing Address - Country:US
Mailing Address - Phone:208-660-5150
Mailing Address - Fax:
Practice Address - Street 1:1621 N 3RD ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3376
Practice Address - Country:US
Practice Address - Phone:208-765-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID33171104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker