Provider Demographics
NPI:1679729321
Name:NEILL, MELISSA ANN (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:NEILL
Suffix:
Gender:F
Credentials:MED, LMHC
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 1278
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093-1278
Mailing Address - Country:US
Mailing Address - Phone:425-954-5659
Mailing Address - Fax:425-230-4884
Practice Address - Street 1:33530 1ST WAY S STE 102
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7332
Practice Address - Country:US
Practice Address - Phone:425-954-5659
Practice Address - Fax:425-230-4884
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60566722101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty