1588036230 NPI number — MELODIE KAROL GALYEN M.S., L.P.C.

Table of content: MELODIE KAROL GALYEN M.S., L.P.C. (NPI 1588036230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588036230 NPI number — MELODIE KAROL GALYEN M.S., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALYEN
Provider First Name:
MELODIE
Provider Middle Name:
KAROL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROUTSON
Provider Other First Name:
MELODIE
Provider Other Middle Name:
KAROL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588036230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11557 W SAN REMO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83686-8307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-617-0768
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4696 W. OVERLAND RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-515-1660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  5918 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)