Provider Demographics
NPI:1366058364
Name:MELISSA M CORY COUNSELING LLC
Entity type:Organization
Organization Name:MELISSA M CORY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-918-0797
Mailing Address - Street 1:1431 E PINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5775
Mailing Address - Country:US
Mailing Address - Phone:208-918-0797
Mailing Address - Fax:
Practice Address - Street 1:2176 E FRANKLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8009
Practice Address - Country:US
Practice Address - Phone:208-515-7661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty