Provider Demographics
NPI:1477032597
Name:SIMMONS, MELISSA FRANCES (CDPT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FRANCES
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:FRANCES
Other - Last Name:WILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3347
Mailing Address - Country:US
Mailing Address - Phone:509-925-9821
Mailing Address - Fax:
Practice Address - Street 1:200 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3347
Practice Address - Country:US
Practice Address - Phone:509-925-9821
Practice Address - Fax:509-925-9073
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60752017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)