Provider Demographics
NPI:1932503067
Name:LABELLE, MELVIN ELSY III (MA)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:ELSY
Last Name:LABELLE
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 NE 5TH ST APT B101
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4725
Mailing Address - Country:US
Mailing Address - Phone:206-454-3947
Mailing Address - Fax:206-726-8564
Practice Address - Street 1:2103 S ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-3615
Practice Address - Country:US
Practice Address - Phone:206-454-3947
Practice Address - Fax:206-726-8564
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60501058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health