Provider Demographics
NPI:1144374646
Name:HUBER, MELISSA LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEIGH
Last Name:HUBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-0293
Mailing Address - Country:US
Mailing Address - Phone:435-828-8379
Mailing Address - Fax:
Practice Address - Street 1:38 E 100 N
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2122
Practice Address - Country:US
Practice Address - Phone:435-781-8000
Practice Address - Fax:435-781-8001
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377299-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical