Healthcare Provider Details

I. General information

NPI: 1679729321
Provider Name (Legal Business Name): MELISSA ANN NEILL M.ED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33530 1ST WAY S STE 102
FEDERAL WAY WA
98003-7332
US

IV. Provider business mailing address

PO BOX 1278
LINCOLNTON NC
28093-1278
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-5659
  • Fax: 425-230-4884
Mailing address:
  • Phone: 425-954-5659
  • Fax: 425-230-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60566722
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: