Healthcare Provider Details

I. General information

NPI: 1407668783
Provider Name (Legal Business Name): MELISA HOLDWAY, LMHC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E LAKE ST. SUITE C
MEDICAL LAKE WA
99022
US

IV. Provider business mailing address

PO BOX 997
MEDICAL LAKE WA
99022-0997
US

V. Phone/Fax

Practice location:
  • Phone: 509-721-0290
  • Fax: 509-565-3025
Mailing address:
  • Phone: 509-721-0290
  • Fax: 509-565-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MELISA RENAE HOLDWAY
Title or Position: OWNER
Credential: LMHC
Phone: 509-844-4758