| Doctor Name: | MELISSA A BOLEY |
| NPI Number: | 1578732293 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCP |
| License Number: | LPCP233 |
| Business Practice Address: | 333 South Main St Ste 104 Ketchum, ID - 83340 |
| Business Phone Number: | 2087267584 |
| Business Fax Number: | |
| Mailing Address: | Po Box 5865, KETCHUM |
| State: | ID |
| Postal Code: | 833405865 |
| Phone Number: | 2087267584 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2008 |
| NPI Last Update Date: | 02/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | LPCP233 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |