Provider Demographics
NPI:1750882635
Name:MELISSA RUTH LCPC LLC
Entity type:Organization
Organization Name:MELISSA RUTH LCPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-841-1704
Mailing Address - Street 1:910 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7321
Mailing Address - Country:US
Mailing Address - Phone:208-841-1704
Mailing Address - Fax:
Practice Address - Street 1:1015 W HAYS ST STE 207
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5424
Practice Address - Country:US
Practice Address - Phone:208-918-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)