Healthcare Provider Details

I. General information

NPI: 1013639046
Provider Name (Legal Business Name): MELINDA ELLEN COOK LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9111 RYELAND DR
PASCO WA
99301-9167
US

IV. Provider business mailing address

9111 RYELAND DR
PASCO WA
99301-9167
US

V. Phone/Fax

Practice location:
  • Phone: 208-790-5970
  • Fax: 509-542-7695
Mailing address:
  • Phone: 208-790-5970
  • Fax: 209-542-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.61691538
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8911141
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: