Provider Demographics
NPI:1083874085
Name:MORELAND, MELISSA ANNE (CDPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MORELAND
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:MORELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 2605
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2605
Mailing Address - Country:US
Mailing Address - Phone:509-454-4143
Mailing Address - Fax:509-454-4115
Practice Address - Street 1:12 S 8TH ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-3020
Practice Address - Country:US
Practice Address - Phone:509-454-4143
Practice Address - Fax:509-454-4115
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2020-03-10
Deactivation Date:2019-03-27
Deactivation Code:
Reactivation Date:2019-04-12
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WALW60675429104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)