Provider Demographics
NPI:1013566298
Name:HERRICK, MELISSA R (CG, CO)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:R
Last Name:HERRICK
Suffix:
Gender:F
Credentials:CG, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1906
Mailing Address - Country:US
Mailing Address - Phone:509-667-0679
Mailing Address - Fax:
Practice Address - Street 1:326 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1906
Practice Address - Country:US
Practice Address - Phone:509-667-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60927107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health