Provider Demographics
NPI:1982219929
Name:ROQUE, MELANIE ANNE (LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANNE
Last Name:ROQUE
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2204
Mailing Address - Country:US
Mailing Address - Phone:206-307-5866
Mailing Address - Fax:
Practice Address - Street 1:4326 TERRACE DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2204
Practice Address - Country:US
Practice Address - Phone:206-307-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61097621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty