Provider Demographics
NPI:1568057610
Name:DOUGLAS, MELISSA (LMFTA, MHCA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMFTA, MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14452
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VLY
Mailing Address - State:WA
Mailing Address - Zip Code:99214-0452
Mailing Address - Country:US
Mailing Address - Phone:509-995-1614
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE STE 200G
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7576
Practice Address - Country:US
Practice Address - Phone:208-718-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60970280101YM0800X
WA60970281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health