Provider Demographics
NPI:1962665331
Name:MAYNES, MELISSA FATIMA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FATIMA
Last Name:MAYNES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:FATIMA
Other - Last Name:PUCCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, LMHC, CDP
Mailing Address - Street 1:6623 133RD ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-6316
Mailing Address - Country:US
Mailing Address - Phone:253-538-7303
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60013965101YA0400X
WALH60088360101YM0800X
WALF60143370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health