Provider Demographics
NPI:1255486619
Name:MORGAN, MELISSA JANE (CDP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JANE
Last Name:MORGAN
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 1:1128 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4102
Mailing Address - Country:US
Mailing Address - Phone:425-771-4305
Mailing Address - Fax:
Practice Address - Street 1:909 SE EVERETT MALL WAY
Practice Address - Street 2:SUITE C364
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3746
Practice Address - Country:US
Practice Address - Phone:425-349-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)