Provider Demographics
NPI:1093890519
Name:GORSUCH-CLARK, MELISSA R (MSW)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:R
Last Name:GORSUCH-CLARK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 TIETON DRIVE, SUITE C
Mailing Address - Street 2:C/O CATHOLIC FAMILY & CHILD SERVICE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-9750
Practice Address - Street 1:5301 TIETON DRIVE, SUITE C
Practice Address - Street 2:C/O CATHOLIC FAMILY & CHILD SERVICE
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3478
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:509-966-9750
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00045050101YM0800X
WA1041C0700X
WALW601457831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health