Provider Demographics
NPI:1851056386
Name:CHUNG, MELISSA M
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 11TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3212
Mailing Address - Country:US
Mailing Address - Phone:509-902-8585
Mailing Address - Fax:509-902-8030
Practice Address - Street 1:314 S 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3212
Practice Address - Country:US
Practice Address - Phone:509-902-8585
Practice Address - Fax:509-902-8030
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61473059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health