Healthcare Provider Details

I. General information

NPI: 1841603388
Provider Name (Legal Business Name): MELISSA JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ROCKEFELLER AVE # MS 305
EVERETT WA
98201-4071
US

IV. Provider business mailing address

3000 ROCKEFELLER AVE # MS 305
EVERETT WA
98201-4071
US

V. Phone/Fax

Practice location:
  • Phone: 425-212-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60855674
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: