Healthcare Provider Details

I. General information

NPI: 1518382589
Provider Name (Legal Business Name): MELISSA OVERTON MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22722 29TH DR SE STE 100
BOTHELL WA
98021-4420
US

IV. Provider business mailing address

22722 29TH DR SE STE 100
BOTHELL WA
98021-4420
US

V. Phone/Fax

Practice location:
  • Phone: 425-205-5455
  • Fax:
Mailing address:
  • Phone: 425-205-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLF60711763
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF607117763
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLF60711763
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerMARRIAGE AND FAMILY THERAPIST LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: