Provider Demographics
NPI:1427613751
Name:RILEY, MELISSA (MED, PCLC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:MED, PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MERCURY ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1672
Mailing Address - Country:US
Mailing Address - Phone:406-560-2467
Mailing Address - Fax:
Practice Address - Street 1:305 W MERCURY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1672
Practice Address - Country:US
Practice Address - Phone:406-560-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
83186101YS0200X
MTBBH-PCLC-LIC-37026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool