1407668783 NPI number — MELISA HOLDWAY LMHC PLLC

Table of content: (NPI 1407668783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407668783 NPI number — MELISA HOLDWAY LMHC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELISA HOLDWAY LMHC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407668783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 997
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDICAL LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99022-0997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-721-0290
Provider Business Mailing Address Fax Number:
509-565-3025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 W LAKE STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MEDICAL LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-721-0290
Provider Business Practice Location Address Fax Number:
509-565-3025
Provider Enumeration Date:
01/23/2025

Additional Information

Authorized Official

Authorized Official Last Name:
HOLDWAY
Authorized Official First Name:
MELISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-565-0686

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013415223 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1699091868 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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