Provider Demographics
NPI:1265519839
Name:MOATS, MELINDA (MED)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:MOATS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 270TH ST NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8021
Mailing Address - Country:US
Mailing Address - Phone:360-629-8232
Mailing Address - Fax:360-629-6063
Practice Address - Street 1:10011 270TH ST NW
Practice Address - Street 2:SUITE B
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8021
Practice Address - Country:US
Practice Address - Phone:360-629-8232
Practice Address - Fax:360-629-6063
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health