Provider Demographics
NPI:1528670676
Name:LARK, MELODY HOPE (MS, CRC, LCPC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:HOPE
Last Name:LARK
Suffix:
Gender:F
Credentials:MS, CRC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2517
Mailing Address - Country:US
Mailing Address - Phone:406-366-2848
Mailing Address - Fax:
Practice Address - Street 1:481 LOWER AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-8016
Practice Address - Country:US
Practice Address - Phone:406-538-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-44037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional