Healthcare Provider Details

I. General information

NPI: 1033626239
Provider Name (Legal Business Name): MELISA SUE LINDEN AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISA SUE VALENTINE AAC

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 14TH AVE
LONGVIEW WA
98632-1604
US

IV. Provider business mailing address

PO BOX 1670
LONGVIEW WA
98632-8014
US

V. Phone/Fax

Practice location:
  • Phone: 360-749-8056
  • Fax: 360-749-8060
Mailing address:
  • Phone: 360-749-8056
  • Fax: 360-749-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: