Provider Demographics
NPI:1750891404
Name:HANSEN, MELISSA (LMFTA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CAMBRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PEER COUSNELOR
Mailing Address - Street 1:2603 BRIDGEPORT WAY W STE D
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2603 BRIDGEPORT WAY W STE D
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4724
Practice Address - Country:US
Practice Address - Phone:253-778-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist