Provider Demographics
NPI:1063633519
Name:FRASER, MELISSA (CDP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2472
Mailing Address - Country:US
Mailing Address - Phone:253-473-7474
Mailing Address - Fax:
Practice Address - Street 1:12202 PACIFIC AVE S STE D
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:WA
Practice Address - Zip Code:98444-5157
Practice Address - Country:US
Practice Address - Phone:253-535-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005585101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)