Provider Demographics
NPI:1649578899
Name:MITCHELL, MELANIE E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 1ST AVE APT 1106
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1140
Mailing Address - Country:US
Mailing Address - Phone:206-718-6170
Mailing Address - Fax:
Practice Address - Street 1:19550 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-5426
Practice Address - Country:US
Practice Address - Phone:206-718-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60116073103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist