Charles Alvin Melick III, LCSW - 37691

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LCSW-37691 Issued in ID

Practice address

2275 W Broadway St
Ste. G
Idaho Falls, ID 83402-2902

Phone

(208) 524-7400

Fax

(208) 524-8004

NPI assigned

Jul 16, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Cam Melick Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554249600000",
    "number": "1215344726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 GALLUP ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834045606",
            "telephone_number": "801-669-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 W BROADWAY ST",
            "address_2": "STE. G",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834022902",
            "telephone_number": "208-524-7400",
            "fax_number": "208-524-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELICK",
        "first_name": "CHARLES",
        "middle_name": "ALVIN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LCSW - 37691",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-16",
        "last_updated": "2019-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "ID",
            "license": "LCSW-37691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAM",
            "last_name": "MELICK",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.