Provider Demographics
NPI:1780801811
Name:STANDISH, MELISSA HIGGINS (MA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:HIGGINS
Last Name:STANDISH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3128
Mailing Address - Country:US
Mailing Address - Phone:360-802-5000
Mailing Address - Fax:360-825-7861
Practice Address - Street 1:1806 PORTER ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3128
Practice Address - Country:US
Practice Address - Phone:360-802-5000
Practice Address - Fax:360-825-7861
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4397101YM0800X
WA1335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist